Pattern of histocompatibility (HLA) antigen distribution among Nigerian (West African black) diabetics.

The pattern of HLA distribution was studied in 70 Nigerian diabetics. There was no association at all between HLA-B8 and insulin-dependent diabetes mellitus (IDDM). There was an increased frequency of HLA-B15 in all categories of patients: those with onset before 40 yr, those with onset after 40 yr (P less than 0.05), those with IDDM (P less than 0.05), and those with non-insulin-dependent diabetes mellitus (NIDDM). HLA-B7 was slightly increased in frequency contrary to the findings in Caucasian IDDM. HLA-A10 and HLA-Aw32 were increased in all the groups of patients, while HLA-B17 was higher in those with onset after 40 yr (P less than 0.02) and NIDDM (P less than 0.02). HLA-Bw35 was decreased in all categories of patients. However, all the observed deviations fell short of statistical significance when correction was made for the number of antigens tested for. Comparison of the data with those in other black populations revealed that the over-all pattern of HLA distribution in black diabetics is rather disparate and still relatively ill defined. It is concluded that the pattern of HLA and diabetes association in Nigerian diabetics would appear to be different from that in most other racial groups including North American and South African blacks. There is, however, a need to further study larger numbers of Nigerian diabetics and other black population groups so that a clearer picture may emerge.

Neoplastic change in chronic leg ulcer.

Seventeen cases of chronic leg ulcers were examined, 12 males and five females, with a mean age of 45 years. The average duration of ulcers was 21 years. Eleven of the cancers arose from ulcers that recurrently healed and broke down. Three arose from ulcers that never healed and three from stable scars. Treatment was by various levels of amputation in nine patients and by excision and skin grafting in one. Histological findings showed 16 cases to be squamous cell carcinoma while one case was sarcomatous in appearance. Most of the cases were poorly differentiated and findings of pseudoepitheliomatous hyperplasia were significant. This was thought to represent earlier stages of fetoplasia which in itself may continue for many years and may be a prelude to frank neoplasia. It was therefore suggested by the authors that the laboratory study of fetal antigens or other fetal markers in these types of lesions may be useful. It was also suggested that careful examination of deeper tissues in lesions where pseudoepitheliomatous hyperplasia has been found is necessary to ascertain that there is no undetected malignancy.

Small bowel neoplasms in a tropical African population.

At the University of College Hospital, Ibadan, Nigeria, in a 17-year period, 54 cases of small bowel neoplasms were seen. The most common was lymphosarcoma (29.62%) followed by malignant lymphoma (12.96%). Burkitt's tumour was not seen in anyone above the age of 16 years. Three cases in this series were histopathologically benign. The presentation is usually silent until a complication sets in.

Primary malignant tumors of bone: incidence in Ibadan, Nigeria.

An account of primary malignant bone tumors in Africans is presented in this series. The study analyzes 170 Nigerians with bone neoplasms diagnosed over the 17-year period 1960-1976. It accounted for 1.28 percent of tumors registered in the Cancer Registry of the University College Hospital, Ibadan. There were 119 male and 51 female patients, with ages ranging from 4 to 75 years. The most common symptom was painful swelling. Trauma was associated with this condition. The pattern of behavior of these tumors conforms with other reports in the literature, but it showed some geographical variations. The most common tumor in the series was osteosarcoma, although there was no association of Paget's disease, which is very rare in Nigerians. Attention is also called to the presence of osteolytic conditions in the metaphysical region of a long bone, which may be due to osteomyelitis caused by Histoplasma duboisii and which has been confused with a malignant bone tumor in this environment.

Adenocarcinoma of the large bowel in Nigerians: a clinicopathologic study.

This paper analyzes 320 cases of colorectal adenocarcinoma at the University College Hospital, Ibadan, Nigeria over a period of 18 years. The sex ratio was 1.5:1 in favor of males; the average age when first seen was 44 years. The symptom complex was weight loss, bloody mucoid stool, altered bowel habit, and abdominal mass. Eighty per cent of rectal cases were in the lower third of the rectum. Most cases were very advanced at the time they were first seen. The association of infective granuloma, notably schistosomiasis and amebiasis, occurred in 11 cases. This probably had diagnostic significance but the etiologic significance is still conjectural. Eighty per cent of the tumors were well-differentiated adenocarcinoma, while 20 per cent were of other histologic variants. In spite of advanced disease, resection was possible in 66 per cent of colonic and 45 per cent of rectal cases. Although the number of cases of colorectal cancers treated yearly in the hospital has increased significantly in the last few years, it is suggested that the hitherto low treatment rate may be attributable to social unacceptability of a permanent colostomy.

Pancreatic carcinoma.

Carcinoma of pancreas is not uncommon in Africa where the prognosis seems to be worse than in cases seen in Europe and North America. The reason for this poor prognosis is because patients with this disease are seen in medical institutions at late stages.There seems to be a rise also in the incidence of this disease in our environment. This increased incidence may be real or apparent, and may be related to the rise in hospital consciousness in the population.As seen in Ibadan, the pattern of the disease is not much different from that reported from other parts of Africa.

Maxillary malignant ameloblastoma with intraorbital extension: report of case.

The case of an aggressive and malignant ameloblastoma of the maxilla in a 22-year-old Nigerian man has been presented. The features that may lead to the development and diagnosis of malignancy in this type of tumor are briefly described and discussed. The relatively young age of this patient, especially in an environment in which medical advice is sought very late, is noteworthy.

Aggressive basal cell carcinoma in Nigerians.

It is important to emphasize that basal cell carcinoma occurs in black Africans, a fact denied in some reports. The present study shows that the disease appears to behave more aggressively in the African, particularly in albinos, than in Caucasians. In albinos preventive measures should be employed regularly.

Needle biopsy of the pleura in Nigeria.

The results of needle biopsy of the pleura carried out on 200 patients are presented. Biopsy was diagnostic in 60% of tuberculous pleural effusions and in 74% of cases of malignant effusions. The histological appearance of chronic fibrosis was seen in 34%, of which half were subsequently found to have tuberculosis.

Infective pericarditis in Nigerian children.

53 children with infective pericarditis were seen at the University College Hospital, Ibadan, between 1967 and 1976. Their ages ranged from 10 days to 15 years but 53% of them were aged 5 years and below. Cough, fever, and breathlessness were the most common symptoms; cardiac decompensation was evident in over 30% of them, 23% had muffled heart sounds, but a pericardial friction rub was audible in only one. The main pathogens identified were Mycobacterium tuberculosis (11 cases), Staphylococcus aureus (11 cases), Escherichia coli (4 cases), Pneumococcus and Pseudomonas (3 cases each). Most of the patients had some other associated infection--such as, bronchopneumonia (12 cases), empyema thoracis (10 cases), lung abscess (10 cases), septicaemis (6 cases), and osteomyelitis (3 cases). Errors in diagnosis were common, the diagnosis having been missed in 72% of the cases identified at necropsy. Even if the correct diagnosis had been made during life and appropriate treatment given, the mortality rate (36%) was high. It is suggested that the onset of cardiac failure in any child with bronchopneumonia, empyema, or lung abscess should always arouse a suspicion of infective pericarditis.

Maxillary African histoplasmosis mimicking malignant jaw tumour.

An account is given of an unusual presentation of solitary Histoplasmosis duboisii of the jaw simulating a malignant neoplasm. This report is of interest for two reasons; firstly, the rarity of such a presentation and secondly, the extensive search of the literature which has failed to produce another case. The rationale for our treatment is also briefly discussed.

A clinicopathologic review of benign giant cell tumors of tendon sheaths in Ibadan, Nigeria.

Thirty-four patients (19 female, 15 male) with benign giant cell tumors of tendon sheaths were studied from the University College Hospital, Ibadan, Nigeria. Ages ranged from eleven to sixty years. The main presenting symptoms were swelling in ten patients and pain in five. Twelve patients gave history of trauma. Only three patients had bony erosion. Gross pathologic and histologic features of the giant cell tumors of the sheath are discussed. Two illustrative cases show the characteristic behavior of the lesion.

An evaluation of the absorption spectra of antigens from Entamoeba histolytica (Ibadan strains).

By means of chromatography different fractions of antigens from Entamoeba histolytica (Ibadan Strains) have been separated. All the different fractions have been tested for antigenic reactivity using agar gel diffusion technique. The intact antigen, as well as, the three antigenically reactive fractions were found to have ultra-violet absorption spectra in the region 258 and 278 millimicron. By virtue of this physico-chemical property amoebic extract(s) was found to simulate a mononucleotide Deoxy-5-methyl-cytidilic-acid. Such a unique structure of the extracts was used to suggest a mechanism for the possible low antigenicity of the organism based on its inability to induce a protective antibody response in human amoebiasis.

Pulmonary alveolar microlithiasis.

A case of pulmonary avleolar microlithiasis is reported. This is of especial interest as it is the first case to be reported from Africa South of the Sahara. The clinical presentation of the patient follows a similar pattern as that of cases already described by other workers. The diagnosis in this case was made in life by a combination of radiological examination and a lung biopsy. The clinical presentat on and aetiology of the condition are briefly discussed.

Drug and immuno-diagnostic resistant amoebic liver abscess in Ibadan: an elucidation of a possible mechanism.

A thick fibrous walling of amoebic abscess of the liver is very rare. Using as a basis the case of drug and immunodiagnostic resistant amoebic liver abscess in an adult Nigerian, an account is given of the possible mechanisms for such therapeutic and diagnostic failure. A theory of blood-abscess cavity barrier is postulated and suggested as a mechanism for the constant failure to detect antibodies to E. histolytica in the small percentage of cases of amoebic liver abscess (Morris, Powell and Elsdon-Dew, 1970). A study of the rate of diffusion of amoebic excretion/secretion through a thick fibrous tissue or artificial membrane of comparable properties is strongly advocated.

An unusual case of tuberculous endometritis association with hyponatraemia in an adult Nigerian

A case is described of tuberculous endometritis associated with hyponatraemia probably resulting from inappropriate secretion of anti-diuretic hormone. An extensive search of the literature has failed to reveal another documented case of this association (AU)