scholarly works
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Item Squamous cell carcinoma of the cervix simulating an advanced malignancy of the ovaries(College of Medicine, University of Ibadan, Ibadan, 1998) Obisesan, K. A.; Adeyemo, A. A.; Fawole, A. O.; Adesina, O. A.A 40-year-old woman was diagnosed as having stage II squamous cell cervical carcinoma and managed with radiotherapy. Three months after treatment, she presented with features suggestive of an advanced ovarian tumour including gross abdominal swelling, bilateral ovarian tumours, multiple tumour seedlings in the abdominal cavity and ascites. There was also pleural effusion. Operative findings revealed widespread intra-abdominal metastases whose histology, contrary to expectations, showed squamous cell carcinoma of cervical origin. Distant metastases from squamous cell carcinoma of the cervix are rare. A high index of suspicion is necessary to detect this unusual mode of presentation.Item A three year clinical review of the impact of angiotensin converting enzymes inhibitors on the intra hospital mortality of congestive heart failure in Nigerians(1996) Adewole, A. D.; Ikem, R. T.; Adigun, A. Q.; Akintomide, A. O.; Balogun, M. O.; Ajayi, A. A.Angiotensin converting enzymes inhibitors are now regarded as the cornerstone of congestive heart failure therapy owing to established reduction in mortality and the symptomatic amelioration following their use. Although the response to converting enzyme inhibitor therapy may be influenced by race, we have reported a trend to reduce intra hospital mortality, the correction of hyponatremia and shortened hospitalization in Nigerians treated with converting enzyme inhibitors. We have now conducted an extended retrospective study, to evaluate the trends in the use of enalapril or captopril and its impact on prognosis in Nigerian patients with heart failure alone, admitted between January 1992 to December 1994. The proportion of heart failure treated with (captopril or enalapril) increased from 37pc in 1992, to 50pc in 1993, to 65pc in 1994. The demographic variables and cause of heart disease were similar in patients treated with converting enzyme inhibitors (n = 55) and those treated conventionally (n = 36). The cumulative mortality among converting enzyme inhibitors treated patients, was (8/55, 14pc) compared to patients not treated (17/36, 48pc) x2 = 12.4; p < 0.0001. There was no sex predilection in mortality (M = 25pc, F = 28pc, mean 27pc). However, initial serum Na+,125mmol was significantly (x2 = 11.1; p < 0.001) more common in the dead patients, 25pc compared to the survivors discharged home 7.5pc. The median hospital stay was 17 days in captopril treated survivors (range two to 44 days) and 19 days (range four to 67 days) in conventionally treated patients. Thus converting enzyme inhibitor therapy may reduce intra hospital mortality in Black Africans hospitalized for congestive heart failure and shorten hospital stay, despite the epidemiologically low plasma renin in Blacks. Hyponatremia may be a poor prognostic index in heart failure in our patients, and its reversal by converting enzyme inhibitors may reflect neurohormonal inhibitor. Earlier and more wide spread use of angiotensin converting enzyme inhibitors in Nigerian and Black Africans with chronic heart failure is now clearly indicated.Item Maternal height and prior viginal delivery as predictive factors in trail of labour after one caesarean section(Informa Healthcare USA, Inc, 1997) Ajayi, A. B.; Babarinsa, A. I.; Adewole, I. F.A retrospective study of 304 booked parturients with one previous lower segment caesarean section for non-recurrent indications was carried out with regards to factors predicting successful trial of vaginal delivery. The height of the parturients, as well as a history of a previous vaginal delivery appeared to be predictive factors of success. Seventy per cent of the parturients succeeded in delivering vaginally. The mean fetal birthweight was 3362 g for women with vaginal delivery, while the mean maternal height was 1.58 m. Of those who needed a repeat caesarean section, surgical intervention in 46.15% of the patients was indicated by poor cervicometric progress, which might have been appropriately addressed by oxytocin augmentation and careful monitoring in labour. Regarding prior vaginal delivery, only 31.1% of parturients with a negative history, but 63.15% with a positive history, had a successful trial. Three cases of ruptured uterus were all the result of unacceptable delay in carrying out an abdominal delivery when it was clearly indicated. A large prospective study into this aspect of obstetric care will probably define additive effects of these two definite factors.