Pathology of cause of death from penetrating weapons in the Niger Delta region of Nigeria: an autopsy study of 254 cases.

AIMS AND OBJECTIVES: To study the pattern of death caused by penetrating weapons. This is a prospective autopsy study of 254 cases over 8 years (1995 - 2002) SUBJECTS AND METHODS: A retrospective analysis of all the medico-legal autopsies performed by the authors on bodies in which the circumstances of death suggested the use of penetrating weapons over a period of 8 years was carried out by the authors. RESULTS: A total of 254 bodies that died during close combat, communal clashes, militant attacks and armed banditry of penetrating weapons were recorded. The youngest was 2 years old male while the oldest was 75 years old male. The highest death toll occurred between the ages of 20-49 years 197(77.6% cases) with a peak at the age group 20 - 29 years 75(29.5%) cases. There were 218(85.8%) males and 36 (14.2%) females giving a male to female ratio of 6:1. The most common cause of penetrating death was gunshot missiles 136(53.5%), while the most common anatomic site of the wound was the chest wall 85(33.5%). Instant death occurred in 179(70.5%) cases and haemorrhagic shock caused the death of 229(90.2%) cases, while the brain was the most common organ lacerated 61(24.0%). CONCLUSION: Penetrating wounds were commonly sustained in close combats, during communal clashes, militant and armed robbery attacks, and youth restiveness in the Niger Delta region of Nigeria. Guns which are prohibited by law and other sharp and pointed instruments were freely used. The condition is preventable by enforcing stringent laws, but it resulted into a lot of mortalities.

Drowning in the Niger Delta region of Nigeria: an autopsy study of 85 cases.

AIMS AND OBJECTIVES: To study the frequency distribution of gender, age, cause and circumstances of drowning in the Niger Delta region of Nigeria, using autopsy. MATERIALS AND METHODS: The autopsies were performed and reported by the authors covering 1st January 1998 to 31st December 2009, inclusive after being served with the coroner's inquest forms by the police. Bio-data and other variables were the age, sex, the environment in which the bodies were recovered and the pattern of death of the victims. The photographs used were taken by police at autopsy. RESULTS: A total of 85 drowned bodies were studied during the period under review. The youngest was a year old male and the oldest was a 76 year old male. Males were 63 (74.1%) and females 22 (25.9%), giving a male to female ratio of 2.9:1. The highest frequency of death occurred in the age group 50-59 years, 21 (24.7%). Most of the bodies 48 (56.5%) drowned in the river, accidental drowning was the most common circumstances of death, 68 (80.0%) and asphyxial death was the most common pattern of death 72 (84.7%). CONCLUSION: Death from drowning is a common but preventable public health problem in the Niger Delta region of Nigeria, since most of the victims drowned accidentally mainly due to lifestyle and psychosocial problem.

Problems of identification associated with victims of aerodisaster: the Port Harcourt experience in December 2005.

BACKGROUND: The problems associated with identification of victims after mass disaster such as aero-accident require an elaborate study with an attempt at proffering solutions in the midst of limited facilities. METHODOLOGY: This is a case study of aero-disaster carried out by the authors at Port Harcourt International Airport on 10th December 2005. Information was adequately disseminated through different media to alert the public to come for the identification of the bodies. The 106 victims were then separated into those whose bodies were intact with few areas of burns, crushed/multiple fractures, those with severe burns, and dismembered or disintegrated bodies. RESULTS: Problems of identification was noticed in 26 (24.5%) of the victims which form the basis for this study. Those disputed by more than one family n = 11 (42.3%), those without dispute but very difficult to identify n = 6 (23.1%) and those that could not be identified n = 9 (34.6%). The cause of the identification difficulty also ranged from total disintegration of the bodies n = 9 (34.6%), severely burnt bodies n = 12 (46.2%) to those crushed with multiple fractures n = 5 (19.2%). CONCLUSION: Problems of identification of severely injured victims of aero-disaster in a limited facility setting can be minimized if strict and well documented pre-travel biometric profiles are taken. Facility for DNA fingerprint, forensic odontologists and forensic anthropologist should be provided. There should also be institution of aviation accident investigation team (AAIT) and mass disaster planning team (MDPT) to aid the identification of victims and probe into the cause and effect of the accident.

Postmortem findings of victims of sexual assault: a study of 15 autopsies in the Niger Delta region of Nigeria.

AIMS AND OBJECTIVES: To study the frequency, status of the victims and assailants as well as the pattern of death in sexually assaulted females. SUBJECTS AND METHODS: A eight year (1st January 1995 to 31st December 2002) autopsy study of sexual assault in the Niger Delta region of Nigeria. Coroner's autopsies performed by the authors at different parts of the Niger Delta region of Nigeria, where the circumstances of death and autopsy finding fit into sexual assault and/or complications were studied after being served with the Coroner's inquest forms by the Police. Reports and death certificates were returned to the coroner through the police. RESULTS: A total of 1,265 autopsies were performed by the authors during the period under review of which 15 cases were deaths from sexual assault constituting 1.2% of the total autopsies. The youngest was 7 years old while the oldest was 59 years old. The highest frequency of death n=4(26.7%) occurred in the age group 10-19 years. Unmarried females n=6(40.0%) were the most common victims. Militants n=7(46.7%) were the most common real/suspected assailants and Asphyxial death n=7(46.7%) was the most common pattern of death of which neck break was the foremost n=4(26.7%). CONCLUSION: Death from sexual assault on women is becoming a common event that is posing an undue social problem to the victims, relations and the government in the Niger Delta region of Nigeria. There should be a government intervention to arrest and prosecute the perpetrators of this crime. This will discourage other assailants from committing the crime and thereby reducing the frequency of death.

Pathology of deaths from carbon monoxide poisoning in Port Harcourt: an autopsy study of 75 cases.

BACKGROUND: Carbon monoxide (CO) poisoning is a notable cause of death at homes and industries that is posing public health problem worldwide that requires an elaborate study. OBJECTIVE: To study and characterize deaths resulting from the noxious gas (CO). DESIGN: A ten year (January 1st, 1995 December 31st 2004) autopsy study. SETTING: Port Harcourt, Nigeria. METHODOLOGY: Coroners and hospital autopsies performed by the authors at the University of Port Harcourt Teaching Hospital (UPTH), other hospitals and private mortuaries in Port Harcourt on deaths from carbon monoxide poisoning were studied over ten years. The circumstances of death reported by police were accidental, homicidal or suicidal; and other autopsy findings were used for the study. RESULTS: A total of seventy five autopsies were studied; out which 21 (28.0%) were females and 54 (72.0%) males giving a ratio 1:2.6 male dominance. The highest frequency of death 25 (33.3%) occurred in the age group 60 69 years; while the least 3 (4%) occurred in the age group 0 9 years. The youngest was an unborn 7 month old male fetus while the eldest was 85 years old female. The most common was accidental carbon monoxide poisoning which accounted for 48 (64%) cases. While Homicidal CO poisoning .was 24 (32%) and suicidal CO poisoning was 3 (4.0%). Body recovered from fumy electric generator rooms was 46 (61.3%) while least frequency was bodies recovered from naked flame 3 (4%). CONCLUSION: Carbon monoxide poisoning is posing a serious public health problem when ever it occurs. There is need for public enlightenment about this gas as it is related to fumes from generator, car exhausts, poorly ventilated rooms and enclosed chambers in order to reduce the carnage associated with it both at home and industries.

Aero-disaster in Port Harcourt, Nigeria: a case study.

BACKGROUND: Aero-disaster in Nigeria is posing a serious problem to government, the public and relatives of victims, as many lives are lost in a single event. MATERIALS AND METHODS: A case study based on an incident at an international airport in Nigeria on December 10, 2005. Detailed autopsy was performed on 97 fully identified bodies out of the 106 victims. Variables considered include ages, sex, pattern of injuries and death as well as problems associated with identification of bodies. RESULTS: A total of 97 (91.5%) out of the 106 deaths recorded were autopsied. Nine (8.5%) bodies were beyond identification, and hence autopsy could not be properly done on them. Fifty-nine (60.8%) were males and 38 (39.2%) were females, giving a ratio of 1.4:1. Sixty-one (62.9%) were children and adolescents below the age of 20 years. Severe burns 27 (27.8%), multiple injuries with burns 21 (21.6%), inhalation of fumes 20 (20.6%), multiple injuries only 16 (16.5%), severe head injury alone 11 (11.3%) and ruptured viscous 2 (2.1%) were the causes of death at autopsy in that order of frequency. CONCLUSION: Aero-disaster, though rare in Port Harcourt, is posing a serious problem in Nigeria in recent times. Various agencies should be established to adequately control mass disasters in Nigeria. Adequate maintenance of aircraft and strict observation and enforcement of aviation laws may drastically reduce the frequency of accidents and subsequent deaths.

Pathology of death from severe head injuries in Rivers State: a study of sixty eight consecutive cases in five years.

BACKGROUND: Traumatic head injury and subsequent death is a public health problem in Nigeria. There is an urgent need to study the various factors leading to this problem. OBJECTIVE: To study the cause and characteristic of fatal head injuries. DESIGN/SETTING: A five year (1998 2003) autopsy study in Rivers State, Nigeria. RESULT: A total of 68 deaths from severe head injuries were studied. Traumatic head injury occurred in every age of both sexes. The youngest was a day old female while the oldest was a 72 year old male. The age group 20 29 years was most affected 26 (30.9%). Males were 55 (82.4%) and females 13 (17.6%) giving a ratio of 4.7:1. Road traffic accident 25 (36.8%) and gunshot 16 (23.5%) were the most common cause of head injury and death. Fractures of the vault of the skull 37 (54.4%) were the most common type of head injury and death. Others include fracture of the base of skull 15 (22.1%), combined fracture of the base of skull and vault 4 (5.9%). Intracranial hemorrhage 9 (13.2%), cerebral laceration 2 (2.9%) and cerebral contusion 1 (1.5%). There were associated injuries in 36(52.9%) cases. CONCLUSION: Head injury is most common cause of death especially in road traffic accidents, gun shot and assault in this environment. There is an urgent need to address the frequency of RTA and gun handling to drastically reduce these fatalities.

Fine needle aspiration cytology in the diagnosis of palpable tumours in Rivers State, Nigeria.

BACKGROUND: There is an increasing popularity of fine needle aspiration cytologic diagnosis of palpable tumours over histologic diagnosis despite the accuracy of histologic diagnosis. OBJECTIVE: To compare cytologic and histologic diagnosis of palpable tumours in Rivers State. DESIGN AND SETTING: A prospective descriptive study at the University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt. METHODS: Using the methods previously described, tumour aspirates were obtained and stained with Giemsa Hematoxylin and Eosin or pap as appropriate and covered with a cover slip. RESULTS: One hundred and sixty seven (167) FNAC specimens from patients aged 3-74 years were studied. Most of the biopsies (81.6%) were obtained from patients below 50 years with the highest frequency in the age group 40-49 years (20.4%). Females predominated with a ratio of 5.2:1. The commonest tissue aspirated was the breast (51.5%) while the least was the salivary gland (1.2%). Out of the histologically confirmed cases, the FNAC was 85.6% accurate. CONCLUSION: FNAC diagnosis of palpable tumors is accurate and reliable as histologic diagnosis if handled by an experienced pathologist.

Correlation between Clinical and Autopsy Diagnoses in 150 Cases Seen in University of Port Harcourt Teaching Hospital; Port Harcourt

Background: Autopsy is a veritable tool for auditing the accuracy of clinical diagnosis. This study determined the accuracy of clinical diagnosis of diseases using autopsy result. The present report was informed by the unusual presentation of this case and the intent of increasing the index of diagnostic suspicion. A brief appraisal is provided of the clinical parameters; management strategies and challenges. Method: A twelve year consecutive clinico-autopsy study. (1st Jan 1995 - 31st Dec; 2006) at University of Port Harcourt Teaching Hospital (UPTH); was carried out. A total of 150 patients who were previously diagnosed of various diseases and treated for variable period of time; and later died were thoroughly autopsied on request to ascertain the cause of death. Of the 2848 autopsies performed during the study period; 150 were hospital autopsies representing 5.3of the total autopsies. The 2698 (94.7) medicolegal autopsies were excluded from the study. Result: The autopsies were performed on patient of both sexes of different ages. Ninety (60) autopsies were males and 60 (40) female; giving a male to female ratio of 1.5:1. Out of 150 clinincally diagnosed cases; autopsy accurately confirmed 127 (84.6) (84.6concordance rate) and varied in 23 (15.4discordant rate). Conclusion: Autopsy pathology is beneficial to the clinician; the surviving relatives and constitutes a vital tool for medical education. It should be incorporated in the patient care and management delivery system in the country

Tumours of the Vulva in Port Harcourt; Nigeria. A 13-Year Clinico Pathological Study

The aim is to ascertain the pattern and frequency of vulval tumours as seen at the University of Port Harcourt Teaching Hospital. Forty (40) vulval tumours were used for the study. Twenty nine (72.5) were benign and eleven (27.5) were malignant. Patients of age 50 years and above were most affected 24(60). The most common clinical presentation was elevated and ulcerated plaques9 (22.5). Condyloma accummatum was the most common benign tumour while squamous cell carcinoma was the most common malignant tumour. It is concluded that vulval tumours are rare in this environment and that the malignant variants present at advanced stage of the disease in later ages. They constitute a remarkable morbidity and mortality especially in the obese and chronically ill menopausal women

Urological Malignancies in Port Harcourt; Nigeria: a 14-Year Review

Background: Urological malignancies are complex; covering the urinary system in both sexes and the genital system of males. They are common in this setting and posing a lot of problems to the patients. In most cases; the disease terminates in the death of the patient. Aim: To study the pattern and frequency of urological malignancies. Methods: All the urological tissues histologically diagnosed as malignant at the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria between 1990 and 2003 were retrospectively studied. Variables such as the age and sex of the patients; anatomical site of the cancer; laterality of the tumours; clinical presentation and the histological types were obtained from the theatre operation register; patient's case notes; histology request forms; reports and autopsy reports. Results: There were 270 histologically confirmed urological malignancies during the period under review. This accounted for 11.3of the total malignancies and affected all ages of both sexes with a male to female ratio of 9.8:1 . The 70 years and above age group were most affected [103(38.1)] and carcinoma of the prostate was the most frequent [189(70.0)]. Adenocarcinoma of the prostate gland was the leading histological variant [187(64.0)] and urinary outflow obstruction was the most common clinical presentation [62(23.0)]. Conclusion: Urological malignancies are fairly common in this environment and carcinoma of the prostate gland is dominating

Pathology of firearm mortalities in the Niger Delta region of Nigeria: a study of 136 consecutive autopsies.

A prospective autopsy study of firearms-related death was carried out by the authors in the Niger Delta region of Nigeria. The purpose of the study was to evaluate the pattern, frequency, and anatomical sites of wounds, also the cause of death and the age and sex distribution of victims. The autopsies were performed after being served with the coroner's inquest forms. In all cases standard autopsy procedures were adopted and reports issued. A total of 136 consecutive firearm deaths were autopsied. There were 122 (89.7%) males and 14 (10.3%) females, giving a male to female ratio of 8.7:1. The highest number of deaths, 95 (69.8%), occurred in the age group of 10-39 years with a peak of 51 (37.5%) deaths at 20-29 years. In 112 (82.4%) cases death occurred from homicidal gunshot wounds. The commonest targets of gunshot wounds were the head, 58 (42.6%); multiple anatomical sites, 30 (22.1%); chest, 16 (11.8%); abdomen, 11 (8.1%) and neck, 10 (7.4%). Haemorrhagic shock was the cause of death in 131 (96.3%) cases. Significant causes of traumatic death in the Niger Delta region of Nigeria are gunshot wounds and associated complications. Stringent laws on illegal firearms handling should be passed and enforced by the government to reduce the frequency of such deaths.

Pathology of Common Diseases of the Thyroid Gland in Port Harcourt

Background: Thyroid diseases are rare in this environment but are more frequent in Western and Northern parts of Nigeria. These diseases present with neck swellings; pains and resulting in high morbidity and mortality rate as well as posing cosmetic problems. Aim: To study the frequency; age distribution and histological types of thyroid diseases. Design/ Setting: A ten-year (1994-2003) retrospective study in Port Harcourt; Nigeria. Methods: Histologic slides were reviewed to ascertain the type of diseases in all cases. The age; sex and clinical presentations were extracted from the histology consultation forms; surgical notes; day books; radiological reports and patient's case file. Results: Thyroid disease accounted for 0.9of biopsies received during the period under review. The lowest frequency occurred in the ages 0 - 10 and 61 -70 years; with one case (1.3) each. The highest occurred in the age group 31-40 years; which recorded 31 cases (38.8). The youngest was a 10 - year old male while the oldest was a 70-year-old female. Eight cases (10.0) occurred in males while 72 (90.0) occurred in females giving a female to male sex ratio of 9:1. Metabolic disease (colloid goitre) was the most common; occurring in 42 (52.0) cases. The least common was inflammatory diseases; 3 (3.8) cases. The most common clinical presentation was neck mass; 64 (80.0) cases. Conclusion: This study confirmed the rarity of thyroid diseases in the Port Harcourt environment and colloid goitre was the most frequent disease. The predominance of females needs an elaborate population based study

Uterine sarcomas in Port Harcourt, Nigeria: a 12-year clinico-pathologic study.

BACKGROUND: Uterine sarcomas are rare gynecological malignancies with a high mortality. There is the need to determine its frequency, clinical presentation and histologic variants. This may form the basis for further research and management in order to reduce the morbidity and mortality associated with it. DESIGN: A 12-year hospital based retrospective clinico-pathological study. SETTING: University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria. SUBJECT: Women with histologically diagnosed uterine sarcomas. METHOD: Previously prepared histologic slides were retrieved and reviewed to confirm the diagnosis and to ascertain the histological type of the uterine sarcoma. Clinical data such as the age and the mode of presentation were extracted from the case notes, histology request forms and reports. RESULTS: Eleven histological reports satisfied the criteria for the study which accounted for 0.5% and 4% of total malignancies and gynaecologic malignancies respectively in UPTH during the period under review. Malignant mixed mesodermal tumors was the most common (36.4%). The highest frequency of the tumors occurred in the age group 50-59 years (45.5%) and abnormal vaginal bleeding was the most common clinical presentation (36.4%). CONCLUSION: Uterine Sarcomas are rare world wide; most common above the age of 50 years, with variable clinical presentations and associated with high morbidity and mortality rate.

Hepatocellular carcinoma in Port Harcourt, Nigeria: clinicopathologic study of 75 cases.

BACKGROUND: Hepatocellular carcinoma (HCC) is a complication of liver cirrhosis caused by hepatitis B viral infection, fungal infection and genetic factors. This disease though having a silent course is associated with variable morbidity and mortality in this environment. METHODS: Previously prepared histologic slides were retrieved and re-evaluated to confirm the diagnosis. Clinical data such as the age, sex, clinical presentations, histologic grading and cause of death were extracted from the case notes, histology request forms and autopsy protocol forms. RESULTS: Seventy five cases were used for the study during the period under review. The youngest was a 14 year old male while the oldest was a 66 years old male. Male to female ratio was 2:1. Majority (28%) occurred in the age group 40-49 years. Upper abdominal mass was the most common clinical presentation (30.7%) and well differentiated hepatocellular carcinoma was the most common (64.0%) histologic grade. Trabecular inusoidal pattern (49.3%) was the most common histologic type (pattern) while upper gastro-intestinal bleeding (38.7%) was the most common cause of death at autopsy. CONCLUSION: Hepatocellular carcinoma is a notable malignancy of the liver associated with variable morbidities and mortality as it has an insidious onset and very aggressive course.

Pathology of vaginal cancers in Port Harcourt, Nigeria. A 14-year study.

BACKGROUND: Primary malignancies of the vagina are rare as most are metastatic lesions. This study documents a 14-year experience in a tertiary institution in South Southern, Nigeria. DESIGN AND SETTING: A retrospective study of clinical presentations including anatomic sites and histopathologic diagnosis of cancers of the vagina in the University of Port Harcourt Teaching Hospital METHODOLOGY: The tissues received for histologic diagnosis were fixed in 10% formal saline, processed and embedded in paraffin wax. Microtome sections of the tissue (3 -5 microns) were taken and mounted on glass slides and stained with hematoxylin and eosin (H & E) stains. Cases in which both the slide and blocks could not be traced were excluded from the study. RESULTS: A total of 2389 malignancies were diagnosed during the period under review of which 344 were gynaecological. Fifteen cases of vaginal cancers satisfied the criteria for the study, constituting 0.63% and 4.36% of the total and gynaecological malignancies respectively. Five cases (33.33%) occurred in children below the age of 20 years, while 10 cases (66.67%) were in adults. The peak incidence was in the group 0 9 and 60-69 years. Irregular vaginal bleeding was the commonest clinical presentation and the upper posterior vaginal wall was the commonest anatomic site. The most frequent histological type was the non-keratinizing squamous cell carcinoma while FIGO stage 111 (46.67%) cancer was the commonest stage at presentation. CONCLUSION: Vaginal cancers are rare in this environment but they contribute to high morbidity and mortality among women of all ages as the disease is diagnosed at an advanced stage.

Uterine Sarcomas in Port Harcourt; Nigeria a 12-Year Clinico-Pathologic Study

Background : Uterine sarcomas are rare gyneacologic malignancies with a high mortality.There is the need to determine its frequency; clinical presentation and histologic variants.This may form the basis for further research and management inorder to reduce the morbidity and mortality associated with it. Design : A 12-year hospital based retros- pective clinico-pathological study. Setting : University of Port HarcourtTeaching Hospital (UPTH); Port Harcourt; Nigeria. Subject: Women with histologically diagnosed uterine sarcomas. Method : Previously prepared histologic slides were retrieved and reviewed to confirm the diagnosis and to ascertain the histological type of the uterine sarcoma. Clinical data such as the age and the mode of presentation were extracted from the case notes; histology request forms and reports. Results:Eleven histological reports satisfied the criteria for the study which accounted for 0.5and 4of total malignancies and gynaecologic malignancies respectively in UPTH during the period under review. Malignant mixed mesodermal tumors was the most common (36.4).The highest frequency of the tumors occurred in the age group 50-59 years (45.5) and abnormal vaginal bleeding was the most common clinical presentation (36.4). Conclusion : Uterine Sarcomas are rare world wide; most common above the age of 50 years; with variable clinical presentations and associated with high morbidity and mortality rate

Cancrum Oculi in HIV Positive Child : a Case Report

Background: Cancrum oculi; is a very rare type of noma. Very few cases have been reported worldwide.Aim: To report a case of cancrum oculi in a six- month-old HIV positive negroid female. Setting:University of Port Harcourt Teaching Hospital (UPTH); Port Harcourt; Nigeria. Case Report: A six-month-old HIV seropositive negroid female child was seen in UPTH with necrotizing chronic ulcer at the angle of the left eye. There was also an intense oral thrush initially managed by the paediatricians and later referred to the Ophthalmology department for management. Clinical examinations and various investigations suggested the diagnosis of cancrum oculi.Conclusion: Cancrum oculi; like other variants of noma complicate immuno-deficiency or can be a primary disease in immuno-competent patients with poor hygiene. It is a preventable disease

Industrial accidental deaths in the Niger delta region of Nigeria: a study of 32 autopsies in Port Harcourt.

Accidents in the oil industry in the Niger delta region of Nigera raise concerns about safety measures and the management of industrial sites. A total of 32 autopsies were performed after coroners' inquest forms were served on the authors by the State, which serve as consent and request. Standard procedures were adopted in all the cases and the reports were appropriately issued. Death from industrial accidents accounted for 2.5% and 6.1% of total autopsies and accidental death autopsies respectively. The youngest victim was a 19 year old male while the oldest was a 55 year old male. The age group 30-39 years was the most vulnerable. There was a male dominance; (male:female ratio = 9.7:1). The commonest accidents in their order of frequency were: falling from a height, explosion/fire, motor vehicle accidents and falling objects. Multiple injuries, head and neck trauma and drowning were the commonest cause of death at autopsy. Accidental deaths were commoner in the small-scale industries (81%) than in the large-scale industries (19%). This is the first time such a study has been carried out locally. The proportion of accidental deaths in the small scale industries relative to that of the large ones may be attributed to the poor enforcement of safety measures in the smaller industries