Analysis of five-year breast biopsies carried out in the University of Benin Teaching Hospital Benin City

OBJECTIVE: To review the histology of breast biopsies carried out in our hospital with a view to designing management and preventive strategies. PATIENTS AND METHODS: 179 patients who had breast biopsies over a five year-period (January 1999 - December 2003) were included in the study. The patients were sorted out from the records in both the casualty and main theatres of the hospital. The medical records from their case files were analysed in terms of age, sex and the histology of the tissue obtained on biopsy. RESULTS: Benign breast lesions accounted for 73.2% with fibroadenoma constituting a greater percentage. Whereas benign breast lesions were most commonly encountered in the third decade of life, malignant lesions occurred most commonly in the fourth decade. After the age of 60, all the cases analysed were of the malignant variety. CONCLUSION: Young patients with breast lump should be encouraged to come for consultation as most of them are benign. However, any lump in a woman above 30 should be properly screened for cancer. Similarly, any patient who presents with a breast lesion after the age of 60 should be regarded as having breast cancer until proved otherwise.     

Flexible bronchoscopic removal of a three piece foreign body from a child's bronchus

Foreign body aspiration can be a life-threatening event especially in young children because they have smaller diameters of airway lumen, moreover, the delay in the diagnosis and subsequent therapeutic intervention can further increase the risk of morbidity.^{1, 2} A retained foreign body can result in inflammatory response and granulation tissue formation around the object which make the foreign body removal difficult.³ In such situations surgical intervention is usually needed but with interventional pulmonology modalities we can restrict the need for surgery.⁴ Rigid bronchoscopy under general anaesthesia is the gold standard of diagnosis and management of foreign body aspiration.¹ However, nowadays flexible bronchoscopy is more widely available and most pulmonary physicians are trained in its use so it can be used to remove such foreign bodies. We hereby report a case of a neglected foreign body which remained in the bronchus of a child for 11 days, successfully removed by flexible bronchoscopy.     

Histopathology of orbito-ocular diseases seen at University of Benin Teaching Hospital,Benin City

Ninety-three biopsied lesions of the orbito-ocular region seen over a fifteen year period at the Pathology department of the University of Benin Teaching Hospital (UBTH) Benin City were reviewed. The aim was to determine the morphological patterns and the age, sex and site distribution of these lesions. Majority of the lesions (43.3%) were found in children less than 15 years of age. There was no difference in frequency between the two sexes. 41.9% of the lesions were malignant while 58.1% were benign. The commonest site of orbito ocular lesions was conjunctival (55.9%), followed by intraocular lesions (24.7%). About 50% of the lesions of the orbit were inflammatory pseudotumours. Inflammatory pseudotumours also formed the majority (33.3%) of the lesions in the eyelid. However, squamous cell carcinomas were the commonest lesions of the conjunctiva seen accounting for 25% of these. Retinoblastomas formed 95.7% of the intra-ocular tumours seen.     

Admission of hypertensive patients at the University of Benin Teaching Hospital, Nigeria

BACKGROUND: There is a suggestion of an identifiable impact of hypertension on all cause mortality in rural Africa. There is however paucity of hard data on the impact of morbidity or modality from this disease. OBJECTIVE: To determine the contribution of hypertension (HT) to adult morbidity and mortality at the University of Benin Teaching Hospital (UBTH) in Benin City, Nigeria. DESIGN: Retrospective study. SETTING: University of Benin Teaching Hospital. SUBJECTS: Adult hypertensive admissions (HTA) in Benin City, Edo state, Nigeria during the period January 2000 to December 2002. RESULTS: There were a total of 2,852 adult medical admissions during the study period out of which 575 were because of hypertension related morbidity. Only 302 (52.5%) of these were previously diagnosed as hypertensives). The most common hypertensive complication was cerebrovascular accident followed by congestive cardiac failure and chronic renal failure in order of decreasing frequency. The annual adult mortality rate from medical admissions was 5.6%. Mortality due to hypertensive complications constituted 10.5% of overall hospital adult mortality and 16.1% of deaths from medical causes. The annual mortality rate among HTA was 22.1% (252/1000) with a male:female ratio of 2:1. CONCLUSION: The contribution of systemic hypertension to adult morbidity and mortality is very significant. There is need for more concerted effort to create hypertension awareness, and to achieve good control and prevention of hypertensive complications.     

Serum lipid profile and uric acid levels in preeclampsia in University of Benin Teaching Hospital

Background:

Preeclampsia is a pregnancy-specific disease associated with significant maternal and perinatal mortality and morbidity. Lipid abnormality and elevated serum uric acid have been reported as early features of the disease. We aimed to detect the level of serum lipid profile and uric acid abnormalities in severe preeclamptics in Benin City and to measure their clinical significance.

Materials and Methods:

A prospective case-control study was conducted with subjects presenting with severe preeclampsia to the Obstetric Unit of the UBTH, Benin City. Fasting serum lipid profile and uric acid levels of 40 severe preeclamptic subjects and 80 gestation-matched normotensive controls were done at recruitment. The preeclamptic subjects were managed according to our departmental protocol which included stabilisation and delivery. Their sociodemographic and clinical characteristics were used to generate a database for analysis.

Results:

The mean serum uric acid level was 28% higher in severe preeclamptics than normotensive women (5.96 ± 2.54 mg/dl versus 4.30 ± 0.85; P = 0.005). There were statistically significant differences in levels of triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) between the preeclamptics and their normotensive controls (P = 0.006, P = 0.000, P = 0.000, respectively). Abnormal serum uric acid was associated with advanced maternal age (P = 0.000), early-onset preeclampsia (P = 0.000) and abnormal body mass index (BMI; P = 0.000). Low birth weight was more likely in preeclamptics with elevated serum uric acid levels (P = 0.041).

Conclusion:

Abnormality of serum uric acid in preeclampsia was significantly associated with increased frequency of complications but lipid profile abnormalities were not shown in the subjects studied. We recommend a larger scale study to determine lipid profile in normal and complicated pregnancies in our environment.     

345例肺癌的纤维支气管镜检查分析

目的　探讨纤维支气管镜对肺癌的诊断价值及影响活检率的因素。方法　报告 1987年～ 1997年纤维支气管镜检查 34 5例肺癌 ,34 5例毛刷 ,2 95例活检。结果　毛刷阳性率 86 0 9% ,活检阳性 6 1 0 2 % ,术后诊断2 32 % ,鳞癌占 38 2 6 % ,不定型 45 5 1%。结论　纤维支气管镜对肺癌的检查是目前可获得细胞学的重要手段 ,活检阳性率与肿瘤部位、类型、镜下不典型及麻醉等因素有关。     

纤维支气管镜检查并发症的预防及护理

目的:探讨纤维支气管镜检查并发症的预防及有效的护理措施。方法:分析2003年1月~2006年12月纤维支气管镜检查并发症的发生情况。结果:纤支镜检查术后并发症的发生率约为1.63%,无严重并发症的发生。结论:做好充分的术前准备,熟练的术中配合及良好的术后护理,可降低并发症的发生,保证纤维支气管镜检查的安全,有效。     

Massive hemoptysis after a bronchoscopic biopsy in patients with endobronchial tuberculosis

Endobronchial tuberculosis （EBTB） is an infectious disease occurring in the trachea or the bronchus with microbiological and histological evidences of tuberculosis. It is assumed a specific form or complication of tuberculosis. EBTB is combined in 10% to 40% of patients with active pulmonary tuberculosis.     

A 20-year retrospective study of histopathologic patterns of gonadal germ cell tumors in males in the University of Benin Teaching Hospital

Background:

Localization of germ cells tumors to the gonads is not uncommon and has been shown to possess good prognosis with appropriate treatment. Studies on the prevalence and histopathologic features of these tumors in Nigerians are, however, rare. This study was, therefore, aimed at determining the pattern of gonadal germ cell tumors (GGCTs) in Benin and environs.

Materials and Methods:

This was a 20-year retrospective study conducted at the University of Benin Teaching Hospital 9-(UBTH), a tertiary health facility in Benin City. Data were obtained from the histopathology day book of the Department of Morbid Anatomy of the UBTH, and permission was obtained from the UBTH Ethics Committee protocol number ADM/E 22/A/VOL.VH/928 with results displayed in tables and figures.

Results:

Intratubular germ cell neoplasms (ITGN) was the most common GGCT with about 33.3% of the total and was distributed within the fourth to fifth decades of life; benign cystic teratoma and choriocarcinoma were observed to have a low occurrence with 8.3% each found in age groups 11–20 and 21–30 years, respectively. The studied gonadal lesions were most frequent at the left testis and were predominantly premalignant forms.

Conclusion:

This was an index study on patterns of GGCTs in males in UBTH, and it showed that GGCTs in males were predominantly premalignant with ITGN as the most common type of testicular germ cell tumors.     

瑞芬太尼在中老年患者无痛支气管镜检查中的临床作用

目的 探讨瑞芬太尼在中老年患者无痛支气管镜检查中的作用.方法 将120例行无痛支气管镜检查的中老年患者随机分为4组(n=30),A组用丙泊酚麻醉,B、C、D组用瑞芬太尼复合丙泊酚麻醉(瑞芬太尼输注剂量:B组0.05μg·kg-1·min-1,C组0.10 μg·kg-1·min-1,D组0.15 μg·kg-1·min-1).观察各组患者在检查过程中的体动反应、血流动力学变化、丙泊酚用量、检查时间、苏醒时间、离室时间及不良反应.结果 在检查过程中,A组的术中体动和呛咳明显高于其他3组(P＜0.05);在血流动力学上,A组波动较大,B、C、D组相对较平稳,但D组低血压、心动过缓、一过性呼吸抑制发生率均较其他3组高(P＜0.05);丙泊酚用量A组明显高于其他3组(P＜0.05),B组高于C、D组(P＜0.05);在苏醒时间和离室时间上B、C、D组明显优于A组(P＜0.05),C、D组短于B组(P＜0.05).结论 中老年患者在无痛支气管镜检查中可使用瑞芬太尼,且以0.10 μg·kg-1·min-1的瑞芬太尼复合异丙酚麻醉效果较好.     

纤维支气管镜在诊断肺癌中的应用—附112例报告

目的：探讨纤维支气管镜（纤支镜）检查在肺癌诊断方面的价值。方法：采用OLympus Type2 TRFB依次观察气管、隆突、各支气管、发现病变时行直视下刷检及活检,获取标本后常规送病理,抗酸杆菌涂片染色或细菌培养。回顾性分析112例肺癌病人的临床表现及在纤支镜直视下的形态或病理资料,并进行总结。结果：肺癌的症状与体征在临床上无特异性,X线或CT扫描对病变能起到定位作用,而及时的纤支镜检查,对发现病灶、获得早期诊断和根治起到定性作用。对避免误诊漏诊也是至关重要的。结论：纤支镜检查对肺癌的诊断、病理分型和估计预后具有重要意义。     

支气管镜下酷似肺癌的肉芽增殖型气管支气管结核临床分析

目的：通过分析支气管镜下酷似肺癌的肉芽增殖型气管支气管结核（TBTB）的临床资料,提高对本病的诊断水平,避免误诊.方法：回顾性分析2011年10月至2012年10月期间温州医科大学附属第二医院收治的支气管镜下表现酷似肺癌的肉芽增殖型TBTB患者（共10例）的临床资料.结果：TBTB好发于中青年（占90％,9/10）,男女均可发病,临床症状以咳嗽、咳痰、咯血为主,痰菌阳性率低,发病部位以两肺上叶为主（占50％,7/14）,入院漏诊率（为50％）引及误诊率（为50％）高.支气管镜下均见典型新生物,如菜花状、结节状等,表面附有少许坏死物,合并相应气管、支气管狭窄者,与原发性支气管肺癌支气管镜下表现非常相似,影像学及支气管镜下表现与肺癌难以鉴别.经支气管镜检查刷检后涂片找抗酸杆菌阳性7例（7/10）,刷检后病理阳性7例（7/10）;经支气管镜下活检病理见典型结核样改变4例（4/7）;刷检病理及活检病理均阳性3例,刷检后涂片找抗酸杆菌及活检病理均阳性3例;三者均阳性2例.结论：TBTB临床表现缺乏特异性;肉茅增殖型TBTB支气管镜下表现酷似肺癌,结合支气管镜刷检抗酸染色、活检病理可提高其诊断率.     

儿童支原体肺炎临床、影像学及纤维支气管镜诊治研究

目的探讨儿童支原体肺炎的临床、影像、肺功能及纤维支气管镜改变,研究纤维支气管镜介入治疗支原体肺炎的疗效。方法回顾性分析207例支原体肺炎患儿临床资料,并对其中135例胸部X线片表现为肺部大片浸润或肺不张的急性支原体肺炎患儿进行随访研究,其中61例给予纤维支气管镜检查、病变局部介入治疗和大环内酯类抗生素内科治疗(治疗组),74例仅给予大环内酯类抗生素内科治疗(对照组),随访比较治疗组、对照组肺部病变吸收情况。结果207例支原体肺炎患儿临床主要表现为咳嗽207例(100%),发热185例(89.4%),气促49例(23.7%),喘息29例(14.0%),胸痛28例(13.5%),皮疹13例(6.3%);肺部有阳性体征73例(35.3%),外周血白细胞正常93例(44.9%),轻度增高97例(46.9%),血清CRP多有升高;支原体肺炎胸片最常见表现为肺实质阴影(57%,118/207),其中大片浸润阴影98例(47.3%);肺不张37例(17.9%)。139例肺通气功能(75.1%,139/185)有不同程度异常,主要表现为小气道功能改变;纤维支气管镜下均可见黏膜粗糙、肿胀、分泌物附着,管腔分泌物多数呈半透明或灰...     

移植肝穿刺活检268例次病理学观察

目的 研究肝移植术后移植肝多种并发症的临床发生情况、病理学特征和活检诊断作用.方法 收集1999年1月至2011年5月华中科技大学同济医学院附属同济医院器官移植研究所207例受者共268次经皮移植肝穿刺活检组织予以HE、Masson及PAS染色和补体C4d、乙型肝炎病毒表面抗原(HBsAg)、乙型肝炎病毒核心抗原(HBcAg)、丙型肝炎病毒(HCV)、巨细胞病毒(CMV)、细胞角蛋白(CK)19免疫组化染色并予以病理学观察分析.结果 268例次移植肝活检中,缺血/再灌注损伤26例次(9.7％)、急性T细胞介导性排斥反应83例次(31.0％)、急性抗体介导性排斥反应12例次(4.5％)、慢性排斥反应31例次(11.6％)、药物性肝损伤70例次(26.1％)、复发性肝病18例次(6.7％).结论 肝移植术后可发生多种并发症并可通过活检病理学观察予以明确诊断,肝移植临床中应常规开展移植肝穿刺活检病理学诊断.     

Flexible bronchoscopic findings and the relationship to repeated extubation failure in critical children

Background

Extubation failure (EF) in acute pediatric cases causes high morbidity and prolonged hospitalization, some of which might encounter EF repeatedly. This study aims to investigate flexible bronchoscopic findings of airway problems associated with repeated EF (REF) in children.

纤支镜病理活检漏诊35例分析

目的提高临床和病理医生对该项检查的认识水平，减少漏诊发生。方法对35例漏诊病例进行回顾性分析。结果35例患者中，误诊为慢性炎症19例，结核9例，其它7例。结论密切临床和病理医师联系，加强交流与切磋，是提高呼吸系统疾病诊断水平的必由之路。