Endometrial carcinoma following treatment for breast carcinoma in a Nigerian female. A case report and review of the literature

Tamoxifen is the primary hormonal therapy for breast cancer as well as its chemoprevention. It is used in the management of breast cancer because of its anti oestrogenic effect. It is however an agonist on the endometrium with undesirable effects of endometrial proliferation with the risk of endometrial hyperplasia and carcinoma. Several authors have reported cases of endometrial hyperplasia and carcinoma following tamoxifen therapy for breast carcinoma. No such report has been made from Nigeria .This paper presents the first case of endometrial carcinoma following tamoxifen therapy for breast carcinoma in a 52 year old Nigerian female. It also highlights the recommended guidelines for the follow up of women with breast cancer on tamoxifen therapy.     

Malignant Breast Lessions At Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H), Sagamu-a Histopathological Review

Various reports suggest an increasing incidence of breast cancer in Nigeria. The large volume of literature published on the subject of breast cancer bear witness to the interest shown in the subject. We therefore carried out a review of 50 cases of breast cancer recently confirmed histologically by our unit to study their characteristics and compare these with previous reports. A 2- years retrospective review of all histologically diagnosed carcinoma of the breast at Olabisi Onabanjo University Teaching Hospital, Sagamu from 2002-2003 was carried out. The peak age of occurrence was between 40-49 years with mean age of 47.5years. Invasive ductal carcinoma was predominant histologic type in 94% of cases and 72% presented late with advanced disease (Manchester stages 111 and 1V) with dismal prognosis. Surgery was the mainstay of treatment for both early and late disease. To ensure early and prompt detection, presentation and treatment, emphasis should be placed on female education, increasing awareness and encouraging breast self-examination. There is also a need for cancer registration centre in the hospital and a multicentred, controlled study of breast cancer in Nigeria.     

双能X线吸收法与生物电阻抗法测量肥胖儿童身体成分结果比较

目的比较7～15岁肥胖儿童双能X线吸收法（DEXA）与生物电阻抗法（BIA）身体成分测量结果及其与正常儿童的比较,为BIA在肥胖儿童体重控制中的应用提供基础数据。方法选择7～15岁体重正常和肥胖儿童共356名,每组各性别、年龄约10名,分别采用DEXA和BIA测定身体脂肪组织和非脂肪组织成分及骨矿含量,分析肥胖儿童2种方法测量结果的相关性和一致性以及与正常儿童的差异。结果7～15岁男、女肥胖儿童肌肉组织、骨矿含量、脂肪组织和脂肪百分比BIA与DEXA测量结果的相关系数除11～15岁女生骨矿含量外,差异均有统计学意义（P值均〈0.05）,脂肪组织相关系数高于其他指标。7～15岁肥胖儿童BIA与DEXA脂肪百分比测量结果的差值均值有随年龄增长而降低的趋势。男生BIA与DEXA脂肪百分比测量值比较的一致性限为-7.5%～8.6%,女生为-7.5%～11.0%。低年龄（〈13岁）高脂肪百分比组（≥35%）和高年龄（≥13岁）低脂肪百分比组（〈35%）肥胖男、女生脂肪组织指数（FMI）和非脂肪组织指数（FFMI）差值均值较小。结论肥胖儿童BIA与DEXA身体成分测量值的相关性以及一致性与体重正常儿童相比时,结果更好。     

Contribution of congenital malformation to perinatal mortality in Lagos, Nigeria

Over a 17-month period we prospectively recorded identifiable congenital malformations at delivery in singleton births in our hospital. Despite the prevailing religious and cultural belief we carried out autopsies in 41% of the perinatal deaths that occurred during the study period. Out of a total of 63 (21/1000 singleton births) congenital malformations discovered, 21 (33%) were identified at autopsy only. About 16% of total perinatal deaths were due to congenital malformation. Cardiovascular malformations accounted for about 40% of perinatal deaths from congenital malformations followed by central nervous system malformation (23.3%), gastrointestinal malformations (20%), musculo-skeletal malformations (6.7%); renal malformations (3.3%) and others (6.7%). No relationship between maternal age, parity and congenital malformation was found. The results from this study suggest that with the use of autopsy, teratology may contribute significantly to the prevailing high perinatal mortality in Lagos more than was previously thought.     

Fetal macrosomia and pregnancy outcome in Lagos

In an analysis of 6376 singleton births the prevalence of macrosomia was 4.9%; the attending perinatal mortality was 58/1000 compared to 18/1000 in controls. Eighty-three percent perinatal deaths occurred in unbooked patients after prolonged and neglected labor. Mortality and morbidity were weight related; the macrosomic baby delivered by section or by diabetic mother or that died was significantly heavier. There was strong association between maternal age, parity, diabetes, mild hypertension, previous history of a big baby and macrosomia in this study. Pregnancy was significantly prolonged with higher incidence of emergency sections and primary postpartum hemorrhage in mothers of macrosomic babies. Fetal sex does not appear to be an important factor in macrosomia.     

The final diagnosis in patients with a suspected primary malignancy of bone

We investigated the eventual diagnosis in patients referred to a tertiary centre with a possible diagnosis of a primary bone malignancy. We reviewed our database from between 1986 and 2010, during which time 5922 patients referred with a suspicious bone lesion had a confirmed diagnosis. This included bone sarcoma in 2205 patients (37%), benign bone tumour in 1309 (22%), orthopaedic conditions in 992 (17%), metastatic disease in 533 (9%), infection in 289 (5%) and haematological disease in 303 (5%). There was a similar frequency of all diagnoses at different ages except for metastatic disease. Only 0.6% of patients (17 of 2913) under the age of 35 years had metastatic disease compared with 17.1% (516 of 3009) of those over 35 years (p < 0.0001). Of the 17 patients under 35 years with metastatic disease, only four presented with an isolated lesion, had no past history of cancer and were systematically well. Patients under the age of 35 years should have suitable focal imaging (plain radiography, CT or MRI) and simple systemic studies (blood tests and chest radiography). Reduction of the time to biopsy can be achieved by avoiding an unnecessary investigation for a primary tumour to rule out metastatic disease.     

The risks and benefits of radiotherapy with massive endoprosthetic replacement

Between 1966 and 2001, 1254 patients underwent excision of a bone tumour with endoprosthetic replacement. All patients who had radiotherapy were identified. Their clinical details were retrieved from their records. A total of 63 patients (5%) had received adjunctive radiotherapy, 29 pre-operatively and 34 post-operatively. The mean post-operative Musculoskeletal Tumor Society scores of irradiated patients were significantly lower (log-rank test, p = 0.009). The infection rate in the group who had not been irradiated was 9.8% (117 of 1191), compared with 20.7% (6 of 29) in those who had pre-operative radiotherapy and 35.3% (12 of 34) in those who radiotherapy post-operatively. The infection-free survival rate at ten years was 85.5% for patients without radiotherapy, 74.1% for those who had pre-operative radiotherapy and 44.8% for those who had post-operative radiotherapy (log-rank test, p < 0.001). The ten-year limb salvage rate was 89% for those who did not have radiotherapy and 76% for those who did (log-rank test, p = 0.02). Radiotherapy increased the risk of revision (log-rank test, p = 0.015). A total of ten amputations were necessary to control infection, of which nine were successful. Radiotherapy may be necessary for the treatment of a bone sarcoma but increases the risk of deep infection for which amputation may be the only solution.     

Prevalence of HIV among women with vaginal discharge in a gynecological clinic

OBJECTIVE: Vaginal discharge is a common complaint among women with sexually transmitted diseases (STDs) in Nigeria. Given the association between STDs and HIV and the alarming rise in the prevalence of HIV in Nigeria, we performed this study to determine the prevalence of HIV in patients with vaginal discharge. STUDY DESIGN: Between April 2000 and August 2000, women who attended the Lagos University Teaching Hospital and complained of vaginal discharge were adequately counseled for HIV serotest. High vaginal/endocervical swabs and venous blood were taken for microbiological studies and HIV serotest, respectively. RESULTS: Out of the 230 women counseled for HIV serotest 140 (60.9%) consented. The mean age of the 140 was 31.1+/-6.9 years (range 18-50 years). In 31 (22.1%), Candida albicans was isolated, in 26 Gardnerella vaginalis (18.8%), in 17 Staphylococcal spp. (12.1%); and E. coli, Trichomonas vaginalis, and Neisseria gonococcus in 7.9%, 4.3%, and 1.4%, respectively. Four (2.9%) of the 140 patients were HIV seropositive, and all had Candida albicans isolated. The prevalence of HIV among patients with Candida albicans was 12.9%. Association between HIV seropositivity and Candida albicans infection is significant (X2=14.48; p=0.002). CONCLUSION: Candida albicans is a common cause of vaginal discharge among HIV-seropositive women in Lagos.