Akinwumi Oluwole Komolafe

Right atrial myxoma as a possible cause of hemorrhagic stroke and sudden death

Right atrial myxomas are rare primary tumors of the heart. They may remain asymptomatic or eventually cause constitutional signs and symptoms. Less frequently, obstruction of the tricuspid valve occurs, resulting in exertional dyspnea, syncope, or sudden death. Neurological manifestation as initial presentation of atrial myxomas is rarely, if ever, associated with right atrial myxomas and may be secondary to cerebral infarction, cerebral hemorrhage and, more rarely subarachnoid hemorrhage. We review the case of a previously unknown, middle-aged Nigerian man who presented to hospital with severe headache and sudden loss of consciousness. A clinical diagnosis of hypertensive hemorrhagic cerebrovascular accident was made. The patient died suddenly a few hours after presentation. Post-mortem examination revealed a small intracerebral hemorrhage in the left superior temporal lobe as well as a large right atrial myxoma, a ventricular septal defect in the muscular septum, and right ventricular hypertrophy. The liver showed fatty change while the kidneys showed evidence of benign nephrosclerosis. Right atrial myxomas may, therefore, be remotely considered as a cause of intracranial hemorrhage, especially in the presence of predisposing cardiac anomalies such as a ventricular septal defect. Similarly, being a known cause of right heart failure, sudden death, and other constitutional derangements, it may contribute significantly to disease outcome. Hence, it should be given due consideration in the differential diagnosis of cerebrovascular accidents.

Autopsy-certified maternal mortality at Ile-Ife, Nigeria

Aim Maternal mortality is a major health problem, especially in Nigeria, where accurate autopsy-based data on the prevalent causes are not readily available. The aim of this study was therefore to accurately determine the causes of maternal death as seen in a tertiary health facility in Nigeria. Materials and methods This was a descriptive, retrospective review of the postmortem autopsy findings from cases of maternal death at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria over a 5-year period. Analyses were performed for differences in proportions using PEPI computer programs for epidemiologists (P is significant at <0.05). Results A total of 84 cases of maternal deaths were used for the study. Approximately 71.4% of the maternal deaths were due to direct causes and 28.6% were due to indirect causes. The mean age at the time of death was 27.9±7.5 years. Overall, the three leading causes of death were obstetric hemorrhage (30.9%), complications of abortion (23.8%), and nongenital (nonobstetric) infections (14.2%). Of the direct causes of maternal death, obstetric hemorrhage (43.3%) was the leading cause, with postpartum hemorrhage accounting for most (65.0%) of such deaths; other causes included complications of unsafe induced abortion (33.3%) and of labor (11.7%). Of the indirect causes, nongenital infections (50.0%), anemia (25.0%), and preexisting hypertension (20.8%) accounted for the majority of the maternal deaths. There was disparity between the clinical and autopsy diagnoses in 34 of the 84 cases (38.1%). Conclusion The leading causes of maternal death in this study are similar to those in other developing countries. Autopsy is an invaluable tool in accurately determining the cause of maternal death.

Malignant skin lesions in Oshogbo, Nigeria

Introduction The aim of this study is to retrospectively assess the prevalence of some of skin malignancies in our environment and to provide a data base for creating awareness for prevention and early detection of the diseases in order to reduce morbidity and mortality associated with these skin lesions in our environment. Methods This is a retrospective study of all histologically diagnosed malignant skin lesions which presented at Ladoke Akintola University of Technology Teaching Hospital Osogbo Osun State between January 2006 and December 2010. Results Ninety- eight patients presented with skin cancers out of which 60 (61.2%)were males and 38 (38.8%) were females. Malignant melanoma ranked highest followed by squamous cell carcinoma, dermatofibrosarcoma and basal cell carcinoma in that order. Malignant melanoma affects male more than female and it commonly affects lower limbs. Conclusion Skin malignancies pose a burden to the economy of the country. Efforts should be directed toward prevention, early diagnosis and management in order to abolish or reduce morbidity, as well as mortality associated with late presentation of people in the developing countries.

Cardiac tamponade complicating thoracocentesis: a case for image-guided procedure

We present a case of cardiac tamponade that was precipitated by thoracocentesis and discovered at autopsy.

Peculiarities and management challenges of advanced renal cell carcinoma incidentally discovered in pregnancy

Our aim is that urologists, gynecologists, nephrologists, and general practitioners will be reminded that diagnosis of renal malignancies sometimes require a high index of suspicion as they may remain asymptomatic in advanced stages; even as they can also rarely co‐exist with and cause peculiar challenges in pregnancy.

An autopsy review of sudden unexpected natural deaths in a suburban Nigerian population

Introduction: The pattern of sudden unexpected natural deaths (SUND) is known to reflect the disease pattern prevalent in any particular geographic location. Cardiovascular, respiratory and central nervous systems are the most common organ systems contributing to SUND. This pattern appears to be changing in Nigeria in response to the changing demographics and lifestyle. It is, therefore, vital to review the causes of SUND in a typical Nigerian population and compare these with what obtains in other places. Materials and methods: Cases of sudden unexpected natural deaths seen at the OAUTHC, Ile-Ife, Nigeria over a 10-year period formed the basis of the study. Results: SUND accounted for 13.4% of all medico-legal autopsies. The male to female ratio was 2.1:1 while the mean age was 43.1 years ± 19.5 SD. About 54.1% of cases were older than 40 years while only 10.1% were younger than 20 years old. Cardiovascular (28.3%), respiratory (18.2%) and central nervous system (12.6%) disorders were the leading causes of death. Hypertensive heart disease (18.2%), intracerebral haemorrhage (7.5%), chronic glomerulonephritis (6.3%), breast carcinoma (6.3%), bacterial pneumonia (6.3%), aspiration pneumonitis (5.7%) and diabetic ketoacidosis (5.0%) were the leading specific causes. About 83.1% of deaths occurred outside the hospital setting while only 16.9% of deaths occurred during hospital admission. Conclusion: Although hypertension-related disorders constitute a significant proportion of SUND where the pattern is similar to other developing countries and the majority of deaths occur outside the hospital setting.

Pattern of deaths in females in a tertiary health center, south-west Nigeria

Purpose The aim of this study was to review autopsies to determine the pattern of deaths in females at Wesley Guild Hospital, Ilesa, Nigeria. Methods A 9-year retrospective study was done of all autopsies done on females in the Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital, Ilesa, Nigeria, from January 2002 to December 2010. Records of all autopsies done on females during the period were reviewed. Results During the study period 215 cases of female death were autopsied. The age range was 0–75 years (mean = 32.9). Deaths due to trauma were most common (57.2%), followed by obstetric deaths (15.8%). Deaths due to infections and cardiovascular diseases accounted for 13% and 5.6%, respectively. Injuries sustained from automobile accidents were responsible for 88.6% of all trauma deaths. Gunshot injuries accounted was 4.9% of these trauma deaths. The causes of death from automobile accidents included multiple injuries (49.5%), head injury (38.5%), and hypovolemia (8.3%). Obstetric deaths were predominantly due to uterine sepsis (51.5%) and hemorrhagic shock (39.4%). About 39% of deaths from infection were due to septicemia. Acute bacterial meningitis, acute lobar pneumonia, and malaria caused 23.1%, 15.4%, and 7.7% of deaths from infections, respectively. Four cases of sudden unnatural deaths (other than trauma) were recorded. Conclusion Trauma was the most common cause of death in women autopsied in our hospital, and automobile injuries were the most common causes of these trauma deaths. Obstetric deaths ranked second. Sepsis and hemorrhage were the most common causes of these obstetric deaths. Deaths from eclampsia were low. Requests for autopsies on women who died from cancer were few. There is a need for clinicians to ascertain the actual cause of death in women who die from cancer.