DESMOPLASTIC SMALL ROUND BLUE CELL TUMOUR OF THE ABDOMEN - A CASE REPORT.

Desmoplastic Small Round Cell Tumour (DSRCT) is an uncommon malignant type of Small Round Blue Cell tumours with less than 200 cases reported in literature. Notorious for its aggressiveness, its commonest site of affectation is the abdomen, with a predilection for peritoneal cavity and prone to spread to multiple organs. We report a case of a 26-year old male undergraduate who presented with a 6-month history of progressive abdominal swelling associated with abdominal pain, weight loss, and change in bowel habits. He was cachectic with dyspnoea, bilateral pitting pedal oedema, a grossly distended and a palpable huge firm mass measuring 20 x 15cm. Immunohistochemisttry confirmed a diagnosis of DSRCT. An abdominopelvic Computed Tomography (CT) scan showed extensive abdominal and pelvic disease with pulmonary and liver metastases. He could only tolerate one course of chemotherapy due to deteriorating renal function. It ran an aggressive course of 9 months from onset of symptoms to eventual demise of the patient. CONCLUSION: Desmoplastic Small Round Blue Cell Tumour is an uncommon and fatal disease, with no significant improvement in survival despite aggressive multimodality therapy. A high index of suspicion and Immunohistochemistry for accurate diagnosis as well as prompt and effective treatment will improve outcome.

Radiation therapy interruption in a poor resource setting: causes and management..

BACKGROUND: Treatment interruption is the failure to execute approved treatment plan of a patient. This adversely affects treatment outcomeif not properly managed. This retrospective study causes and management of radiation treatment interruptions during High Dose Rate Brachytherapy(HDRB) for carcinoma of the cervix in a teaching hospital in Nigeria. METHODS: Five hundred patients with cervical carcinoma, who received HDRB, post external beam radiotherapy, between August, 2008 and July, 2013 were assessed. They were grouped into (A): those who experienced treatment interruption and (B): those who did not. Each patient was scheduled to receive three fractions of HDRB over 3 weeks. Those in groups A were assessed for the exact treatment fraction missed, the cause and duration of treatment interruption and the actions taken to compensate for non-execution of treatment. RESULTS: A total of 90 patients fall into group A and most (41) of them experienced interruptions in the third fraction of their treatment. The most frequent (44%) causes of treatment interruptions observed among them were patient-related. Record of compensation for treatment interruption was not found in patients' treatment folders. This action may be due to lack of functional procedures for managing treatment interruptions and insufficient follow-up of patients, who never came back for consideration for compensation. CONCLUSION: This study showed that radiation oncology centres need to review their policies for managing treatment interruptions and documentation. Also, the mechanism for patients' follow-up should be strengthened to a reasonable extent to achieve better radiotherapy care.

Pattern of morphine prescription by doctors in a Nigeria tertiary hospital.

BACKGROUND: Morphine was reintroduced into Nigeria after a long period of absence due to technical problems relating to stock accounting. With this reintroduction, prescriber education was commenced in many centers including the University of Ibadan. AIMS AND OBJECTIVE: The aim of this study is to review the morphine prescription habits of the medical doctors practicing at the University College Hospital, Ibadan, and to assess the level of conformity with international guidelines. MATERIALS AND METHODS: All the prescriptions on oral morphine in the hospital's pharmacy records within a 6 months period were reviewed. RESULTS: The results showed that more than half (51.7%) of all morphine prescriptions were from the Radiation Oncology Department, while the newly created Day Care Hospice Unit accounted for 31.8% of the prescriptions. No prescriptions were seen from the Labor ward. Only 1.1% of all the prescriptions conformed to international guideline as contained in the "Blue Book." CONCLUSION: The results showed that there is a need for more education and advocacy programmes to increase awareness among doctors about morphine prescriptions.

Mobile phone radiation and the risk of cancer; a review.

With the licensing of mobile phone operators about 7 years ago, Nigeria joined many countries where worries about the health risks (including carcinogenesis) of mobile phones have become common. Opinions have also been expressed by many, some of which were inaccurate in the light of scientific evidence. This article reviewed the current scientific evidence of the role of mobile phones as possible cancer risk. The preponderance of published research works over several decades including some with over ten years of follow up have not demonstrated any significant increase in cancer among mobile phone users. However, the need for caution is emphasized as it may take up to four decades for carcinogenesis to become fully apparent.

Parity and breastfeeding are protective against breast cancer in Nigerian women.

As the relation between reproductive factors and breast cancer risk has not been systematically studied in indigenous women of sub-Saharan Africa, we examined this in a case-control study in Nigeria. In-person interviews were conducted using structured questionnaires to collect detailed reproductive history in 819 breast cancer cases and 569 community controls between 1998 and 2006. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI). Compared with women with menarcheal age<17 years, the adjusted OR for women with menarcheal age>or=17 years was 0.72 (95% CI: 0.54-0.95, P=0.02). Parity was negatively associated with risk (P-trend=0.02) but age at first live birth was not significant (P=0.16). Importantly, breast cancer risk decreased by 7% for every 12 months of breastfeeding (P-trend=0.005). It is worth noting that the distribution of reproductive risk factors changed significantly from early to late birth cohorts in the direction of increasing breast cancer incidence. Our findings also highlight the heterogeneity of breast cancer aetiology across populations, and indicate the need for further studies among indigenous sub-Saharan women.

Radiation nephritis: anti-inflammatory effect of dexamethasone in adult Wistar rats (Rattus norvegicus) / Nefritis por radiación: efecto anti-inflamatorio de la dexametasona en ratas Wistar adultas (Rattus norvegicus)

The anti-inflammatory effect of dexamethasone on the irradiated kidneys of adult Wistar rats (Rattus norvegicus) was studied. Eighteen adult Wistar rats were, after acclimatization, randomly divided into 3 groups of 6 animals per group. The control group had normal saline, receiving neither drugs nor radiation. The second group received normal saline and radiation. The third group received pretreatment with dexamethasone at 1mg/kg body weight/day for 2 days followed by radiation. Radiation was delivered to the animals as a single fraction of 2.5 Gy of gamma rays from Cobalt-60 source, using an AECL Theatron 780-C Teletherapy machine. After exposure to the different interventions, the animals were sacrificed on the 14th post-irradiation day and the kidneys dissected out from each animal. The renal tissues were subjected to histological processing, and then studied using an eyepiece objective ruler calibrated with a 2mm stage micrometer for histomorphometric studies. The result of the study showed that all irradiated animals suffered weight loss by the 14th day post-irradiation (p<0.05) irrespective of the additional treatment with dexamethasone and this was statistically significant. Histomorphometry showed that the maximum width of the glomerular capsule was significantly greater in the radiation groups than in the control at p<0.05. The maximal glomerular diameter was significantly greater in irradiated animals compared with the control animals at p<0.05. The outcome of this study showed that the intraperitoneal administration of dexamethasone at 1mg/kg body weight/day for 2 days prior to treatment with irradiation did not prevent weight loss nor ameliorate the swelling of the nephrons resulting from the effect of radiation injury to the Wistar rat.

Fue estudiado el efecto anti-inflamatorio de la dexametasona en riñones irradiados de 18 ratas Wistar adultas (Rattus norvegicus). Luego de la aclimatización, aleatoriamente se dividieron en 3 grupos de 6 animales por grupo. El grupo control recibió una solución salina normal, sin recibir drogas ni radiación. El segundo grupo recibió solución salina normal y radiación. El tercer grupo recibió tratamiento previo con dexametasona con 1 mg / kg de peso corporal / día, durante 2 días, seguido de radiación. Los animales fueron expuestos a radiación con una fracción independiente de 2.5 Gy de rayos gamma por una fuente de Cobalto-60, usando una máquina de teleterapia AECL Theatron 780-C. Después de la exposición a las diferentes intervenciones, los animales fueron sacrificados el día 14 post-irradiación y los riñones de cada uno de los animales fueron disecados. Los tejidos renales fueron sometidos a procesamiento histológico, y luego se estudiaron utilizando un objetivo ocular milimetrado calibrado a 2mm para el estudio histomorfométrico. Se demostró que todos los animales irradiados sufrieron pérdida de peso 14 días después de ésta (p <0.05), independientemente de los tratamientos adicionales con dexametasona , siendo estadísticamente significativo. La histomorfometría mostró que el ancho máximo de la cápsula glomerular fue significativamente mayor en los grupos irradiados que en el control en p <0.05. El diámetro máximo del glomérulo fue significativamente mayor en los animales irradiados en comparación con los animales control p <0.05. Los resultados de este estudio mostraron que la administración intraperitoneal, de 1 mg / kg de peso corporal / día durante 2 días, de dexametasona antes de comenzar el tratamiento con irradiación, no impide la pérdida de peso ni permite aliviar el edema de los nefrones, injuria producto de la radiación a las Ratas Wistar.

Pattern of paediatric malignancies seen at the Radiotherapy Department of the University College Hospital, Ibadan, Nigeria.

BACKGROUND: Paediatric tumours are seen by the radiotherapist following referral from other specialists. Patients seen by the radiotherapists may not conform to the full spectrum seen in the hospital. OBJECTIVE: To review the pattern of presentation of paediatric malignancies seen at the radiotherapy department of the UCH, Ibadan. METHODS: Retrospective study of all patients below the age of 12 seen in Radiotherapy Department of UCH, Ibadan over a 19-year period was undertaken. Data were collected from the case files and the radiotherapy treatment cards. RESULTS: 244 cases were evaluated with age ranged between 4 months and 12 years. Male to female ratio was 1.15 to 1.0. 23 tumour types were seen with retinoblastoma accounting for about 45% of all the patients reviewed. Burkitt's lymphoma accounted for only about 2.5%. CONCLUSION: Retinoblastoma, nephroblastoma, intracranial malignancies and rhabdomyosarcoma are the tumours most commonly seen at the Radiotherapy Department of the UCH, Ibadan.

Chemo-radiation in advanced nasopharyngeal carcinoma, disease free after 6 years--a case report.

This is a case report of a patient with advanced nasopharyngeal Carcinoma, (T4 N2 MO) who had chemo-radiation with Cisplatin based chemotherapy and total midplane dose of 60 Gray external beam radiation. Six years after treatment patient has remained disease free and the primary site histologically confirmed disease free with no clinical evidence of regional or distance metastases

The effect of dexamethasone, metronidazole and ascorbic acid on the morphological changes induced by gamma rays on the spinal cord of Wistar rats.

We studied the effects of dexamethasone, ascorbic acid, and metronidazole on the irradiated spinal cord of Wistar rats. Thirty adult Wistar rats were randomly assigned into 3 groups. Five rats served as the control group. Another group of 5 rats were irradiated in the neural axis with 2.5 Gy of gamma rays. The last group of 20 rats were irradiated and then divided into four subgroups of 5 rats each: one subgroup was administered dexamethasone alone, a second subgroup had metronidazole alone, a third subgroup was treated with dexamethasone and metronidazole combined, and a fourth subgroup had ascorbic acid alone, given intraperitoneally for 7 days before exposure to radiation, and also for 5 days after-irradiation. All irradiated animals demonstrated similar vascular changes in form of splitting of the smooth muscle layers of the arterioles of the anterior spinal arteries. Similarly, all the irradiated spinal cord demonstrated shrinkages as noted in the diminution of the neuronal sizes measured by a microscope with a micrometer embedded in the eye-piece objective. The drugs did not individually protect neurons from damage at the level of our investigation. However, the combination of dexamethasone and metronidazole produced a reduction of the degenerative effect of radiation on the neurons when the post-irradiation diameters of the neurons were compared with the control and those of the other experimental groups. We conclude that gamma ray induced damage in the spinal cord may be ameliorated by combining dexamethasone with metronidazole but not by individual treatment with any of the three drugs.

Chemotherapy in the management of advanced gastointestinal non-Hodgkin's lymphoma complicated with entero-cutaneous fistula: a case report.

A case of gastrointestinal non-Hodgkin's lymphoma with entero-cutaneous fistula formation following incomplete tumor resection. Patient was managed conservatively with chemotherapy viz Cyclophos phomide, Adriamycin, Vincristin and prednisolone with total healing of the abdominal wound and closure of the fistula. A case is made for conservative management of entero-cutaneous fistula complicating non- Hodgkin's lymphoma before any radical treatment is contemplated.

Knowledge and attitudes of terminally ill patients and their family to palliative care and hospice services in Nigeria.

BACKGROUND: A palliative care and Hospice service is a neglected aspect of medical discipline especially in a developing country like Nigeria. With the global increase in incidence of cancer and HIV/AIDS and 70% of them presenting late, coupled with limited resources, for effective symptom control, palliative care therefore remains the only option left to improve the quality of life of the patients. OBJECTIVE: To assess the knowledge and attitudes of patients and their relations to palliative care and hospice services {PC&H} and to fashion out appropriate services for the patients. MATERIALS AND METHODS: A total of 130 participants were studied using a questionnaire which comprised of three parts: Socio-demographic variables, Information about Knowledge and Attitudes towards PC&H. RESULTS: Sixty nine were patients while 61 were family members. Ninety four [72.3%] had no knowledge of PC&H regardless of level of education and social status. 109 [84%] agreed that symptoms of the terminally ill patients should be treated to improve their quality of life and 75% of the participants agreed that this will be better done in a Hospice. 106 [83%] participants desire to have hospice established in every community, this again was regardless of tribe CONCLUSION: There is a gross lack of knowledge about PC&H in our community as evidenced among the participants studied. However, there is a positive attitude towards PC&H suggesting a general acceptance, since there is presently no well established Hospice in Nigeria; we recommend that government and Non governmental organizations should assist in this area. A hospital based Hospice might be a starting point.

The management of metastatic bone pain in a developing country: the role of radiotherapy as an adjunct to weak opioids.

Bone pain secondary to metastatic cancer is the commonest intractable pain and is a major concern in most oncology units the world over. Cancer pain management is multidisciplinary in approach, so there is no universal or singular modality of treatment. In a developing country like Nigeria, only external radiotherapy and adjuvant weak opioids are readily available, so it is of interest to review the response of these patients to this management option. This is a retrospective review of 92 patients aged 16-80 years with radiologically confirmed metastatic bone disease associated with pain who received external radiotherapy and weak analgesics. The results showed that 23 (25%) patients had a complete response and 67 (73%) had a partial response within four weeks of treatment. Total response was over 90%, which suggests external radiotherapy has an effective palliative role. The study also demonstrated the pattern of bony involvement among the common cancers seen in our environment. The availability of strong opioids (e.g. morphine and pethidine) will obviously consolidate the gains achieved with external radiotherapy in the management of metastatic bone pain in our environment.

Radiotherapy in the management of early breast cancer in Ibadan: outcome of chest wall irradiation alone in clinically nodes free axilla.

The study was carried out to identify the group of patients with early breast cancer [stage I and II] after surgery in which chest wall irradiation alone was given without lymphatic irradiation thus reducing morbidity and also creating room for more patients on the available limited treatment facility. 92 patients with histologically confirmed early breast cancer that attended Radiotherapy clinic between June 1995 and May 1998 that satisfied selection criteria were studied. They all received External Radiotherapy to the chest wall, meadiasternum inclusive and breast if still in-situ. All also received cytotoxic chemotherapy. Majority of the patients 67 [84.8%] were recurrence free in 2 years while 12 [15.2%] had recurrent disease, the recurrent sites were axilla 4 [5.06%], chest wall 3 [3.80%] and supraclavicular 2 [2.52%]. Average time to recurrence was 3-12 months. In view of majority being recurrence free, chest wall irradiation alone in early breast cancer [stage I and II] could be encouraged, thus creating access to treatment for more patients in centers like ours with limited therapy facilities.

Ketamine anaesthesia for young children undergoing radiotherapy.

Young children with radiosensitive malignant tumours often require sedation or anaesthesia to provide immobility for radiotherapy sessions lasting several days. This paper describes the use of repeated intramuscular ketamine anaesthesia for radiotherapy in children age 1.5 to 5 years. Intramuscular ketamine 5-13mg/kg body weight was administered on 280 occasions to 15 children, the highest number of sessions per child being 30 and the least 9. The airway and cardiovascular parameters were well maintained. The time to complete recovery varied from 15 to 90 minutes (mean 52.5+/-31.7 S.D.). Involuntary movements of the tongue, mouth and limbs were observed in 8 patients (52.3%) during 63 sessions (22.5%) but only necessitated interruption of radiotherapy on 6 occasions (2.1%). Ketamine was found to be safe and effective for sedation of young children in the radiotherapy suite and minimal aneasthetic facilities were required.

Advanced cervical carcinoma in Ibadan, Nigeria: an appraisal of radiation therapy.

This is a retrospective study of 500 patients with advanced cervical cancer (FIGO Stages IIB, III and IVA) who were seen and managed at the University College Hospital Ibadan between 1988 and 1992. External pelvic radiation therapy plus intractivary radioactive caesium brachytherapy was mainstay of treatment. Complete response to therapy was recorded in 68% of patients with stage IIB, 57% in stage III and 41.2% of patients in stage IVA. In patients with stage IIB, the local tumour control was 65%, in stage III patients 54% and in patients with stage IV 41%. The cumulative rates of survival at 5 years (for all the patients-with stage IIB, III and IVa) were 41.5%. The cumulative rates for disease-free survival at 5 years was 25.5%. Radiotherapy as the sole treatment modality in the management of advanced cervical cancer in Ibadan has yielded poor results as revealed in this study. There is an urgent need to evolve a new treatment policy with the aim of improving the response rate and survival in this group of patients.

Human immunodeficiency virus antibody in patients with cancer of the uterine cervix undergoing radiotherapy: clinical stages, histological grade and outcome of radiotherapy.

One hundred and twenty consecutive patients with cancer of the uterine cervix were screened for human immunodeficiency virus (HIV) seropositivity before and after radiotherapy. The severity of the disease in terms of clinical staging and histological grading of HIV seropositive women was compared with that of seronegative women. The result showed a prevalence rate of 4.2% for HIV seropositivity which was similar to the rate quoted for the general populace in Nigeria. The HIV seropositive women presented with more severe disease state than the HIV seronegative women. The mean duration of remission was significantly shorter in the HIV seropositive women following radiotherapy (18.36+/3.96 vs. 24.24+/-6.3 months). It was concluded that HIV infection increases the severity and progression of cancer of the cervix in Nigerians. Radiotherapy has no effect on the patients' seropositivity and possibly no effect on the virus. A more aggressive treatment of carcinoma of the cervix and closer follow-up of HIV seropositive patients following treatment are necessary.

Complications following sedation of paediatric oncology patients undergoing radiotherapy.

Sedation is often required to achieve immobilisation of small children during radiotherapy to avoid irradiation of normal tissues during the course of treatment. At the University College Hospital, Ibadan radiotherapists provide sedation for such patients with administration of parenteral and/or oral promethazine, diazepam, chlorpromazine and paraldehyde. This retrospective review of 84 children aged 1 month to 6 years who received sedation for radiotherapy over a period of twenty-one to twenty-eight days showed that 48% had complications. These included injection cellulitis (85.3%), injection abscess (4.87%), paresis of the lower limb (7.3%), aspiration pneumonia (2.4%). Anaesthetists in developing countries should be encouraged to extend their expertise in caring and resuscitation of sedated or unconscious patients to the radiotherapy unit. This will allow for the use of a wider variety of sedative agents and better monitoring as well as minimise or eradicate complications.