MANAGEMENT OF PROSTATE CANCER IN ACCRA, GHANA.

INTRODUCTION: Africans living with prostate cancer in Africa face problems of early diagnosis and appropriate treatment. AIM: To study the clinical incidence of prostate cancer, risk factors, TNM stage, their management and outcomes. METHODS: A prospective study of Prostate Cancer cases managed at Korle Bu Teaching Hospital and hospitals in Accra, diagnosed by history, abnormal PSA/DRE, physical examination and histologically confirmed by biopsy from 2004 to 2013 was carried out. The cases were TNM staged and managed by approved protocol. RESULTS: There were 669 cases with a mean age 70±0.045SE years, median Gleason Score of 7, organ confined Prostate Cancer(PC) in 415(62%), locally advanced in 167(25%) and metastatic Prostate Cancer in 87(13%) cases. The cases were followed for median of 10 months to ≥ 84 months. Organ confined cases were managed by: Radical Prostatectomy (RP) 92 (13.8%) with a mortality of 0.3%; brachytherapy 70 (10.5%) with a mortality of 0.1% and External Beam Radiotherapy (EBRT) 155 (23%) with a mortality 0.7%. In all, 98 men constituting (14.1%) cases with a mean age of 75+0.25SE years, life expectancy <10 years were treated by hormonal therapy with a mortality of 1.7%. Twenty cases who were for active surveillance (GS6), PSA <10ng/ml, life expectancy <10 years later all opted for EBRT. Locally advanced cases 25% all had neoadjuvant hormonal therapy then Brachytherapy in 3 (0.4%) mortality 0.15% and EBRT in 64 (9.5%), mortality 0.59%. Hormonal therapy was given in 100 (15%) locally advanced cases, mortality 5%. Metastatic prostate cancer cases (13%) were managed by hormonal therapy, mortality 6%. CONCLUSION: Improved facilities and dedicated skilled teams led to a significant rise in proportion of organ confined Prostate Cancer from 15.3% to 62% curable by Radical Prostatectomy, brachytherapy or EBRT with longer disease free survival.

Triple-negative breast cancer among ghanaian women seen at Korle-Bu teaching hospital

Background. Women with African ancestry in the United States and in continental Africa have been found to have exceptionally increased frequencies of triple-negative breast cancer (TNBC); prompting speculation that this risk may have an inherited basis and may at least partially explain breast cancer outcome disparities related to racial/ethnic identity. Our goal was to evaluate the breast cancers diagnosed in one of the largest health care facilities in western Africa; and to compare the frequencies as well as risk factors for TNBC versus non-TNBC. Methods. We reviewed all breast cancer cases that had immunohistochemistry (Novolink Detection system); in 2010. Results. The overall study population of 223 breast cancer cases was relatively young (median age 52.4?y); and most had palpable tumors larger than five centimeters in diameter. More than half were TNBC (130 cases; 58.3%). We observed similar frequencies of young age at diagnosis; stage at diagnosis; and tumor grade among cases of TNBC compared to cases of non-TNBC. Conclusion. Ghanaian breast cancer patients tend to have an advanced stage distribution and relatively young age at diagnosis. The triple-negative molecular marker pattern is the most common seen among these women; regardless of age; tumor grade; and stage of diagnosis. Additional research is necessary regarding the causes of TNBC; so that we can elucidate the reasons for its increased prevalence among women with African ancestry

Pathology and the surgical management of goitre in an endemic area initiating supplementary iodine nutrition.

UNLABELLED: Goitre in the West African sub-region is caused by iodine deficiency and goitrogens in the diet. Supplementary iodine nutrition on a mass scale was started in Ghana in 1996. In areas where iodine deficiency have been corrected the histological pattern of goitre changes and this influences surgical decision making. Data on the histological types of goitre in our institution is lacking. OBJECTIVE: To define the histopathological types of goitre in this initial period of iodine supplementation and relate this to the types of thyroid surgeries that were performed. METHODS: It was a prospective study of consecutive patients who underwent thyroidectomy from January 2003-December 2007. Descriptive statistics was employed in analyzing the data RESULTS: Five hundred and twenty eight cases were studied made up of 470 (89%) females and 58 (11%) males with mean age of 41.98 yrs, SD ± 12.90 yrs. The excised mean thyroid tissue weight was 161.4 g, SD ± 116.3 yrs. Hyperplastic goitres were 373 (70.7%), toxic goitre 70 (13.3%), adenoma 37 (7.0%), carcinoma 25 (4.7%) and thyroiditis 23 (4.4%). Papillary carcinoma accounted for 56% (14) cancers. Subtotal thyroidectomy was performed in 278 (52.7%) of patients, near total thyroidectomy 107 (20.3%), lobectomy 98 (18.6%),total thyroidectomy 24 (4.5%), excision or completion thyroidectomy 20 (3.8%) and de-bulking 1 patient. Overall, complications occurred in 32 patients (6.1%) and were made up mostly of haemorrhage in 10 (1.9%), Hypocalcaemia 10 (1.9%), unilateral Recurrent Laryngeal Nerve(RLN) injury 3 (0.57%), Tracheal collapse 3 (0.57%) and Bilateral RLN injury 2 (0.4%). CONCLUSION: The introduction of iodine supplementation on a mass scale in Ghana is yet to have its fullest impact on thyroid diseases. Goitres are still large and cause pressure effects. Toxic, inflammatory and malignant goitres are gaining prominence, and surgery for malignant goitre was oncologically inadequate.Near total thyroidectomy is recommended as the minimum surgery to avert the need for completion thyroidectomies in view of the lack of preoperative pathological diagnosis of thyroid lesions.

Pregnancy related causes of deaths in Ghana: a 5-year retrospective study.

OBJECTIVE: Data on maternal mortality varies by region and data source. Accurate local-level data are essential to appreciate its burden. This study uses autopsy results to assess maternal mortality causes in southern Ghana. METHODS: Autopsy log books of the Department of Pathology, Korle-Bu Teaching Hospital Mortuary were reviewed from 2004 through 2008 for pregnancy related deaths. Data were entered into a database and analyzed using SPSS statistical software (Version 19). RESULTS: Of 5,247 deaths among women aged 15-49, 12.1% (634) were pregnancy-related. Eighty one percent of pregnancy-related deaths (517) occurred in the community or within 24 hours of admission to a health facility and 18.5% (117) occurred in a health facility. Out of 634 pregnancy-related deaths, 79.5% (504) resulted from direct obstetric causes, including: haemorrhage (21.8%), abortion (20.8%), hypertensive disorders (19.4%), ectopic gestation (8.7%), uterine rupture (4.3%) and genital tract sepsis (2.5%). The remaining 20.5% (130) resulted from indirect obstetric causes, including: infections outside the genital tract, (9.2%), anemia (2.8%), sickle cell disease (2.7%), pulmonary embolism (1.9%) and disseminated intravascular coagulation (1.3%). The top five causes of maternal death were: haemorrhage (21.8%), abortion (20.7%), hypertensive disorders (19.4%), infections (9.1%) and ectopic gestation (8.7%). CONCLUSION: Ghana continues to have persistently high levels of preventable causes of maternal deaths. Community based studies, on maternal mortality are urgently needed in Ghana, since our autopsy studies indicates that 81% of deaths recorded in this study occurred in the community or within 24 hours of admission to a health facility.

Prevalence of BPH and lower urinary tract symptoms in West Africans.

BACKGROUND: BPH and lower urinary tract symptoms (LUTS) are very common among older men in Western countries. However, the prevalence of these two conditions in the developing countries is less clear. METHODS: We assessed the age-standardized prevalence of BPH and/or LUTS among West Africans in a probability sample of 950 men aged 50-74 in Accra, Ghana, with no evidence of biopsy-confirmed prostate cancer after screening with PSA and digital rectal examination (DRE). Information on LUTS was based on self-reports of the International Prostate Symptom Score (IPSS). BPH was estimated using DRE, PSA levels and imputed prostate volume. RESULTS: The prevalence of DRE-detected enlarged prostate was 62.3%, while that of PSA≥1.5 ng ml(-1) (an estimate of prostate volume ≥ 30 cm(3)) was 35.3%. The prevalence of moderate-to-severe LUTS (IPSS≥8) was 19.9%. The prevalence of IPSS≥8 and an enlarged prostate on DRE was 13.3%. Although there is no universally agreed-upon definition of BPH/LUTS, making comparisons across populations difficult, BPH and/or LUTS appear to be quite common among older Ghanaian men. CONCLUSIONS: We found that after age standardization, the prevalence of DRE-detected enlarged prostate in Ghanaian men is higher than previously reported for American men, but the prevalence of LUTS was lower than previously reported for African Americans. Further studies are needed to confirm these findings and identify the risk factors for BPH in both Africans and African Americans.

Colorectal carcinoma: an update of current trends in Accra.

BACKGROUND: Clinical experience and earlier studies indicate that the number of colorectal cancer cases seen annually in the Accra metropolis is increasing. OBJECTIVE: This study was aimed at providing a current update on colorectal cancer in Accra, Ghana. METHODS: A prospective study of confirmed cases of colorectal cancer diagnosed from January 1997- December 2007. RESULTS: Three hundred and fifty-nine colorectal cancer cases were studied. Males were 192(53.5%) and females 167(46.5%) with an annual incidence of 32.6 new cases. The crude incidence rates were 12.53, 9.87 and 11.18 per 100,000 population for males, females and overall respectively. Rectal bleeding 185(51.1%), abdominal mass 76(21.1%), intestinal obstruction 62(17.3%), intestinal perforation nine (2.5%) and iron deficiency anaemia nine (2.5%) cases were the main presentations. There were 168 (46.8%) rectal and 191(53.2%) colon tumours. Two hundred and thirty-one patients had laparotomy with 225 resections, and 128 patients for various reasons did not undergo surgery. The Astler Coller stages of the tumours at diagnosis were C2 84(36.7%), C1 53(22.1%), B2 49(21.4%), D 17(7.4%), B1 14(6.1%) and A 12(5.1%) cases. Adenocarcinoma was the commonest histological type 321(89.4%), with the majority either well-differentiated (62.5%) or moderately well-differentiated (25.6) carcinomas. Poorly differentiated carcinomas accounted for 28 cases (7.8%). Post-operative mortality was 6.1%. Long term survival could not be assessed as the majority of patients were lost to follow up. CONCLUSION: The incidence of colorectal cancer has increased over the last four decades in tandem with an aging population of Accra with adenocarcinoma as the predominant histological type.

Human papilloma virus genotypes in Ghanaian women with cervical carcinoma.

BACKGROUND: Humanpapilloma viruses (HPVs) have been considered to be the necessary and central agents of cervical cancer among women with nearly 80% of cases found in developing countries. OBJECTIVE: To determine HPV genotypes prevalent in Ghanaian women with cervical cancer. DESIGN: Retrospective study. SETTING: Pathology Department, University of Ghana Medical School, College of Health Sciences, University of Ghana. SUBJECTS: Ghanaian women 23 to 80 years diagnosed with cervical cancer. RESULTS: Of the 50 samples genotyped, 49 (98%) were determined as positive for HPV DNA. Eight out of 18 different HPV genotypes were detected and all were high-risk types. In decreasing order of prevalence, were HPV 18 in 42 (84%) samples, HPV 16 in 12 (24%) samples, HPV 45 in three (6%) samples, HPV 39 in two (4%) samples and HPV 35, 52,56 and 66 in one (2%) sample each. Multiple infections were detected in 13 (26%) of the 50 samples, the most common co-infections being HPV types 16/18 (18%). Triple infections were found in two (4%) samples with HPV types 16,18 and 39. HPV type 18 was more relatively frequent in adenocarcinomas and adenosquamous carcinomas than in squamous cell carcinomas. CONCLUSION: Eight high-risk HPV genotypes: 16,18, 35, 39, 45, 52, 56 and 66 were typed, with HPV type 18 being the most prevalent in Ghanaian women with cervical cancer. This is contrary to the worldwide prevalence where HPV 16 is the most common type associated with invasive cervical carcinoma.

Colorectal Carcinoma: an Update of Current Trends in Accra

BACKGROUND: Clinical experience and earlier studies indicate that the number of colorectal cancer cases seen annually in the Accra metropolis is increasing. OBJECTIVE: This study was aimed at providing a current update on colorectal cancer in Accra; Ghana. METHODS: A prospective study of confirmed cases of colorectal cancer diagnosed from January 1997 - December 2007. RESULTS: Three hundred and fifty-nine colorectal cancer cases were studied. Males were 192(53.5) and females 167(46.5) with an annual incidence of 32.6 new cases. The crude incidence rates were 12.53; 9.87 and 11.18 per 100;000 population for males; females and overall respectively. Rectal bleeding 185(51.1); abdominal mass 76(21.1); intestinal obstruction 62(17.3); intestinal perforation nine (2.5) and iron deficiency anaemia nine (2.5) cases were the main presentations. There were 168 (46.8) rectal and 191(53.2) colon tumours. Two hundred and thirty-one patients had laparotomy with 225 resections; and 128 patients for various reasons did not undergo surgery. The Astler Coller stages of the tumours at diagnosis were C2 84(36.7); C1 53(22.1); B2 49(21.4); D 17(7.4); B1 14(6.1) and A 12(5.1) cases. Adenocarcinoma was the commonest histological type 321(89.4); with the majority either well-differentiated (62.5) or moderately well-differentiated (25.6) carcinomas. Poorly differentiated carcinomas accounted for 28 cases (7.8). Post-operative mortality was 6.1. Long term survival could not be assessed as the majority of patients were lost to follow up. CONCLUSION: The incidence of colorectal cancer has increased over the last four decades in tandem with an aging population of Accra with adenocarcinoma as the predominant histological type

Orofacial tumours and tumour-like lesions in Ghana: a 6-year prospective study.

A total of 182 patients with orofacial tumours and tumour-like lesions who attended the oral and maxillofacial surgical department of the Korle-Bu Teaching Hospital, Accra, were studied from 1 January 1998 to 31 December 2003. Both malignant and benign tumours were recorded and were more common among men (99/182, 54%) in whom they were seen most often between the ages of 41 and 70 years. Among female patients they were more common in the 11-20 year age group. The mandible, maxilla, and palate were most often affected. A total of 108 tumours were diagnosed as malignant (59%), 27 (15%) as benign odontogenic tumours, and 47 (26%) as benign non-odontogenic and tumour-like lesions. Malignant tumours were usually detected in men between the ages of 41 and 70 years (43% of all men); whilst benign tumours were evenly distributed between the sexes with more among girls in the 11-20 year age group. The most common malignant tumours were squamous cell carcinoma (SCC), (69/108, 64%) and lymphomas (18/108, 17%). The predominant benign odontogenic and non-odontogenic tumours were ameloblastoma and fibro-osseous lesions, respectively. The usual method of treatment was resection (58/182, 32%).

Hepatitis E virus infection among pig handlers in Accra, Ghana.

OBJECTIVE: To determine the correlates of hepatitis E virus infection (HEV) in a sample of persons who work with pigs. DESIGN: Cross-sectional study. SETTING: Three pig farms in the Greater Accra Region of Ghana. SUBJECTS: Persons who work with pigs seen at the selected pig farms between the months of January and May 2008. RESULTS: One hundred and five persons who work with pigs voluntarily completed a risk-factor questionnaire and provided blood samples for unlinked anonymous testing for the presence of antibodies to HEV. The median age of participants was 36.5 +/- 15.0 years (range 12-65 years). Of the 105 subjects tested, HEV seroprevelance was 38.1%. On multivariate analysis, the independent determinants of HEV infection were being employed on the farm for less than six months (odds ratio (OR) 9.1; 95% confidence interval (95% CI) 1.0-81.4 and having piped water in the household and/or on the farm (OR 3.9; 95% CI 0.4-90.8). CONCLUSION: Consistent with similar studies worldwide, the results of our studies revealed a high prevalence of HEV infection in persons who work with pigs. Further studies need to be done to isolate, characterise the virus and define the clinical and epidemiological significance of HEV infection in this population.

Cervical human papillomavirus infection in accra, ghana.

BACKGROUND: This study was aimed at estimating the human papillomavirus (HPV) prevalence and its determinants among a sample of Ghanaian women. DESIGN: Cross-sectional observational study. SETTING: Gynaecology outpatient clinic of the Korle-Bu Teaching Hospital, Accra, Ghana; the largest tertiary care gynaecology outpatient clinic in Ghana. PARTICIPANTS: Convenient sample of 75 consenting women visiting the clinic. METHODS: Information was obtained through personal interviews using structured questionnaire, Pap smears obtained, and laboratory testing of cervical exfoliated cells was performed. HPV DNA was detected using a GP5+/6+ polymerase chain reaction assay. These data were analyzed using both univariate and bivariate techniques. RESULTS: The mean age of participants was 33.3 years (standard deviation, 9.2) and the percentage of lifetime monogamy was 21.3%. The crude HPV DNA prevalence was 10.7%. Unlike most populations studied so far, HPV prevalence was high not only among young women, but also in middle and old age. Independent HPV determinants were being illiterate (prevalence odds ratio [POR], 13.9; 95% confidence interval [95%CI], 1.9-100) and reporting more than three lifetime sexual partners (POR, 4.6; 95% CI, 1.0-22.2). CONCLUSIONS: The study indicates a high crude prevalence of HPV in a largely polygamous Ghanaian population with a high crude prevalence in older age groups, which may be a distinctive feature of polygamous populations where HPV transmission continues into middle age and cervical cancer incidence is very high.

Surgically correctable adrenal-dependent hypertension: a report of five cases.

SummaryAlthough endocrine causes of secondary hypertension are relatively uncommon, medical practitioners must maintain a high index of suspicion for them in certain categories of patients. Such patients include young individuals, those with difficult-to-treat hypertension and those presenting with symptoms, clinical signs and/or laboratory parameters well-known to be associated with Cushing's syndrome, Conn's syndrome or phaeochromocytoma.This paper reports on 5 patients identified over a 2-year period with various hormonally-active adrenal adenomas causing hypertension in an environment where, hitherto, the occurrence of these conditions was generally thought to be rare. Aspects of the patients' histories, examination and laboratory findings that drew attention to the possibility of the diagnosis in each case are highlighted, as are the confirmatory investigations and management methods used by a multidisciplinary team of medical practitioners. The clinical outcome with appropriate treatment of adrenal-related hypertension is good and can result in significant cost savings in the long term.

Childhood deaths from malignant neoplasms in accra.

SUMMARY BACKGROUND: Malignant neoplasms are set to become a leading cause of childhood death in sub-Saharan Africa as immunization programmes reduce deaths due to infectious diseases. Knowledge of the pattern of deaths from these neoplasms is therefore desirable. OBJECTIVE: To describe the pattern of deaths from paediatric malignancies, compare this to morbidity figures and provide baseline data for planning child care services. METHODS: A 10 year retrospective survey of autopsy cases of paediatric malignancies at the Korle-Bu Teaching Hospital Mortuary was carried out based on autopsy files form January 1, 1990 to December 31, 1999 RESULTS: A total of 252 cases of childhood malignant tumours were retrieved, 139 males and 113 females with a male to female ratio of 1.2:1. The most common malignancy was lymphoma forming 54% of cases and almost all of Non-Hodgkin's type. Non-Burkitts type (29%) was the commonest followed by Burkitts (24%) and Hodgkin's disease only one percent. The lymphomas were followed by central nervous system (CNS) tumours (13%), nephroblastomas(10.3%) leukemias (6.7%) hepatic tumours (4%) and sarcomas (2.6%). Less common tumours were Neuroblastomas (2.4%) and retinoblastomas (2%). CONCLUSION: Overall the pattern of deaths from paediatric malignancies followed the pattern of relative incidence in morbidity figures from Ghana and the subregion except for a relatively higher proportion of deaths from CNS tumours and a lower proportion from sarcomas. The pattern of cancer deaths seen in this study is similar to that seen in advanced countries except that lymphomas replace leukemia as the commonest cause of death.

High-level cerebellar expression of cytokines and adhesion molecules in fatal, paediatric, cerebral malaria.

Although the roles played by systemic tumour necrosis factor (TNF) and interleukin 1beta (IL-1beta), and their upregulation of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and E-selectin, in the pathogenesis of human cerebral malaria (CM) are well established, the role of local cytokine release, in the brain, remains unclear. Immunohistochemistry was therefore used to compare the expression of ICAM-1, VCAM-1, E-selectin, IL-1beta, TNF and transforming growth factor beta (TGF-beta) at light-microscope level, in cryostat sections of cerebral, cerebellar and brainstem tissues collected, post-mortem, from Ghanaian children. Among the 21 children investigated were 10 cases of CM, five of severe malarial anemia (SMA), one of purulent bacterial meningitis (PBM), two of non-central-nervous-system infection (NCNSI) and three children who had no infection (NI) when they died. Parasitised erythrocytes were detected in all of the sections from the cases of fatal malaria (CM and SMA), and sequestered leucocytes were present in most of the sections from the CM cases (but none of the sections from the SMA cases). Significantly elevated vascular expression of all three adhesion molecules investigated was detected in the brains of the 15 cases of fatal malaria and one of the cases of NCNSI (a child with Salmonella septicaemia), and in the malaria cases this showed highly significant co-localization with the areas of erythrocyte sequestration. In terms of the levels of expression of ICAM-1, VCAM-1 and E-selectin, there were, however, negligible differences between the CM and SMA cases. Although TGF-beta showed intravascular and perivascular distribution in all the subjects, its expression was most intense in the PBM case and the CM group. Only in the sections from the PBM and CM cases did TNF and IL-1beta show prominent brain parenchymal staining, in addition to the intravascular and perivascular staining seen in all subjects. The highest observed expression of each of the six antigens studied was in the cerebellar sections of the malaria cases. Endothelial activation in the brain therefore appears to be a feature of fatal malaria and Salmonella sepsis, and in cases of fatal malaria is closely associated with leucocyte sequestration. In the present study, IL-1beta and TNF were only up-regulated in the brains of children with neurodegenerative lesions, whereas TGF-beta was present in all cases.

Hormone receptor expression in male breast cancers.

SummaryMale breast cancers are rare but have been found in higher proportions in Black Africans. Prognostic factors for breast cancers include tumour size, grade and stage, and hormone receptor status. The hormone receptor status is an invaluable guide in the use of adjuvant endocrine therapy, but none of the reports available in the literature from Africa showed any receptor work.This study was conducted to determine the grade, lymph node status and hormone receptor status of male breast cancers in Ghana.Nine archival cases of male breast cancers from the Pathology Department of Korle Bu Teaching Hospital were selected and studied on the basis of the presence of enough material for immunocytochemistry. Haematoxylin and Eosin (H & E) stained slides were reviewed and graded by Bloom and Richardson's criteria. Lymph node status was also assessed and sections were stained for oestrogen and progesterone receptors.Seven of the nine tumours were invasive ductal carcinomas and six of these were grade II, and one was grade III. Four cases had axillary lymph nodes removed at surgery and three were positive for metastases. Six (66%) of the cases were positive for oestrogen receptors with an H score ranging from 20 to 300. Using the criteria of McCarty et al, positivity for oestrogen receptor was reduced to 44%, which is lower than for Caucasians. We believe that this may be explained by the fact that in Ghana male breast cancers are seen a decade earlier. Only two cases were positive for progesterone receptor with an H score of 10 and 75. The two cases positive for progesterone receptors were also positive for oestrogen receptors.It is concluded that hormone receptor study is important in deciding on endocrine and adjuvant chemotherapy in male breast cancers and should be done routinely to help surgeons plan postoperative management of these patients. We recommend further research in this area.

Eosinophilic enteritis--a diagnostic dilemma.

Eosinophilic enteritis is a rare condition of unknown aetiology, although it is generally believed to be due to intestinal allergy. It may mimic peptic ulcer, subacute (or chronic) intestinal obstruction, gastroenteritis, irritable bowel syndrome, and inflammatory bowel disease. The diagnosis is often difficult to make and most cases are only diagnosed after laparotomy/ laparoscopy and biopsy. It can be successfully treated with corticosteroids. We report a case of Eosinophilic enteritis in a 27 year old woman the symptoms of which appeared within six weeks of childbirth. With repeated episodes of abdominal pain, vomiting, occasional loose stools with weight loss, she was investigated and treated for many weeks in three hospitals without success. All investigations were inconclusive. Finally laparotomy revealed inflamed segments of small bowel, a biopsy of which showed Eosinophilic enteritis. The patient was subsequently treated successfully with Prednisolone.

Autopsy studies on still births in Korle Bu Teaching Hospital. II: Causes of death in 93 still births.

In this second of three reports dealing with autopsy studies in 93 still births at the Korle Bu Teaching Hospital, Accra, the causes of death are described. Causes of death were grouped using a combination of the modified Aberdeen and Naeye's classification. Asphyxia was the commonest cause of death accounting for 56% of deaths. The single largest contributing factor to fetal hypoxia was antepartum haemorrhage. Foetal infections were responsible for 13% of deaths and maternal pathologic conditions for 10.8%. The commonest maternal condition causing stillbirth was severe pre-eclampsia. Death was due to fatal birth trauma in 5.4% of cases with lethal congenital malformations and placental growth retardation causing 3.2% of deaths each. It is concluded that the vast majority of factors causing or contributing to late foetal deaths are largely preventable and or controllable. It is recommended that antenatal attendance should commence early and be regular and maternal and foetal monitoring be improved so that potential life threatening conditions can be diagnosed early, appropriate management and counselling instituted and therapeutic abortion or delivery planned. Routine examination of placentae at birth and genetic studies in suspicious cases will enable obstetricians counsel parents about the possibility of occurrence of stillbirth or congenital abnormality in future pregnancies. Autopsy examination of stillbirths is encouraged as this may help elucidate deaths in the cases now classified as due to unknown or unexplained causes.

Autopsy studies on still births in Korle Bu Teaching Hospital: pathological findings in still births and their placentae.

Autopsy and histological examinations were carried out on 93 still born fetuses, whose parents gave consent, and their placentae. The commonest pathological finding was asphyxia induced changes which manifested predominantly as haemorrhages in various organs. The associated placental pathological changes were villous oedema, large placental infarcts (more than 20% of placental volume), increased intervillous fibrin deposition and subchorionic haemorrhage in various combinations. Evidence of fetal infection was present in 9 cases (9.7%) but placental inflammation was present in 24.8% of cases. None of the placentae showed the presence of malarial parasites. Lethal congenital malformations were present in 6.2% and maternal floor infarction in 14% of cases. Autopsy and histological examinations of still-born fetuses and their placentae are useful in providing information that may be relevant in the counselling of parents and the extended family (where appropriate) and in auditing antenatal and intrapartum care.

Diabetes mellitus induced by thecoma-fibroma tumour of the ovary: case report.

A case of Thecoma-fibroma secreting oestrogen to cause insulin intolerance in a post-menopausal woman is presented. Blood levels of sugar became normal 24 hours after removal of the tumor. The possible mechanism is presented.