Management of patients with equivocal signs of appendicitis.

A prospective study of 418 patients referred with a tentative diagnosis of acute appendicitis was carried out to evaluate the conservative approach in patients with equivocal clinical features. One hundred and six patients (25.4%) with unequivocal signs had immediate appendicectomy. Of the remaining 312 patients, 167 were admitted to hospital for observation. Appendicectomy was performed in 28 of these patients due to progression of clinical signs during the observation period. A total of 134 patients (32%) underwent appendicectomy with an accuracy rate of 84.3%, negative laparotomy rate of 9.7% and perforation rate of 19.4%. One hundred and thirty-six patients (32.5%) with alternative diagnosis received appropriate treatment. The remaining patients improved without any specific therapy. At follow-up, recurrent symptoms requiring appendicectomy occurred in eight patients (5.4%) and appendicitis was confirmed in five (3.4%). Active observation before the decision to operate is a safe and effective approach to the management of patients with equivocal features of acute appendicitis.

Tamoxifen in the management of advanced breast carcinoma in Nigerian women.

Twenty-nine Nigerian women with advanced breast carcinoma treated with Tamoxifen (Nolvadex ICI) at a dosage of 20 mg twice daily have been reviewed. Eight of 26 evaluable patients had objective response (31%). No statistically significant association was found between response rate and menopausal status, previous chemotherapy or disease free interval. The drug was well tolerated with a low incidence of side effects. This study suggests that Tamoxifen is a useful drug in the adjuvant management of patients with advanced breast carcinoma in Nigeria.

Fine needle aspiration cytology in the assessment of breast lumps in Ibadan.

Within the period August 1984 to January 1987, 209 needle aspirates of breast lumps were examined cytologically. One hundred and forty-four smears had histological confirmation. The diagnostic accuracy of fine needle aspiration cytology for malignancy is 79% in this study, with a specificity of 97%. The role of fine needle aspiration cytology, as a useful diagnostic tool and a necessary adjunct to clinical examination in the assessment of breast lumps is discussed.

Malignant giant gastric ulcer in a Nigerian.

A case of malignant giant gastric ulcer in a 48-year-old Nigerian is reported. This is a rare lesion in the African. The clinico-radiological features that would heighten the clinical suspicion of this condition are highlighted.

Abdominal wound dehiscence: a review of 60 cases at the University College Hospital, Ibadan.

A total of 212 cases of abdominal wound dehiscence requiring secondary closure occurred in 8632 surgical obstetric and gynaecological laparotomies over a 7-year period ending in December 1981. The incidence of abdominal wound dehiscence at Ibadan was 2.5%. Contaminated wounds were the most susceptible with an incidence of 19%. A detailed review of 60 cases revealed a mean age of 29 years. Wound infection was the most prominent contributory factor. Tension sutures appeared to be ineffective in preventing wound dehiscence. Following secondary closure, 53% of the patients developed further wound complications, mainly wound infection, incisional hernia and repeat dehiscence. The average duration of hospitalization was 35 days and 7% of the patients died post-operatively.

Changes in seminal quality following varicocelectomy in infertile Nigerian males.

Semen analysis in 116 subfertile and infertile patients with varicocele revealed oligospermia (counts less than 20 million/ml) in 66% of patients, asthenospermia (motility of less than 50%) in 59% of patients; and teratospermia (abnormal sperm morphology of greater than 50%) in 65% of patients. The sperm motility and morphology deteriorated with decrease in sperm concentration. After varicocelectomy 53% of all patients showed improvement in the overall semen quality. The best post-operative results were noted in patients who had pre-operative counts over 20 million/ml. Deterioration in semen quality was observed in 6% of all patients. Factors which possibly played a role in the response to varicocelectomy in our environment are discussed.

Cyclic AMP binding proteins in human breast cancer.

The characteristics of a method for measuring cyclic AMP binding proteins in cytosols of human breast cancer are described. Using the assay, binding proteins were demonstrable in all of 100 tumour cytosols. Levels of binding in individual tumours varied from 0.8 to 15 pmol mg-1 cytosol protein (mean value 5 pmol mg-1 cytosol protein) and the dissociation constant ranged from 0.5 to 5.2 X 10(-8)M (mean 1.73 X 10(-8)M). Whilst replicate measurements within a single portion of tumour were reproducible (intra-assay coefficient of variation was between 4.5 and 7.8% and that for inter-assay variation was between 2.1 and 4.0%) there were often considerable differences in levels of binding proteins between different portions of the same tumour. Similar intra-tumour variations have been reported for other binding proteins and steroid receptors. The inter-relationships with such parameters may elucidate whether the differences are associated with variations in cellularity, cell type, or other specific factors.

Clinical assessment of tumour size in primary breast carcinoma.

In a consecutive series of 100 operable breast carcinomas clinical and mammographic assessment of tumour size each resulted in only 75% being placed in the correct T category when compared to the actual tumour size. In a further 50 breast carcinomas it was shown that an accurate assessment of actual tumour size could be obtained by subtracting the thickness of the skin, fat and subcutaneous tissue in the corresponding area in the contralateral breast from the clinical measurement obtained using calipers (adjusted clinical size). The T category using this method was correct in 49 out of the 50, significantly better than clinical measurement or mammographic assessment of tumour size (p less than 0.003 McNemar's Test). Analysis of the regression lines obtained comparing clinical measurement, mammographic assessment and adjusted clinical size with actual tumour size showed that: clinical measurement overestimated actual tumour size by 0.5 to 1 cm; mammographic assessment overestimated small tumour and underestimated larger ones, whereas the adjusted clinical size never differed by more than a fraction of a centimeter from the actual size. This new method of assessment of tumour size allows accurate pre-operative selection of patients into appropriate treatment options.