FACULTY OF CLINICAL SCIENCES
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Item Topical anaesthesia for pain relief during high dose rate brachytherapy for carcinoma of the cervix(2015) Elumelu-Kupoluyi, T. N.; Abdus-salam, A. A.; Eriba, L.O."Purpose: To determine the clinical efficacy of a local anaesthetic spray of 10% xylocaine in reducing pain and discomfort in patients undergoing high dose rate (HDR) brachytherapy. Patients and Method: Ninety two consenting patients diagnosed with cervical cancer and planned for HDR as part of their treatment were enrolled for the study. Each patient had three sessions of brachytherapy following the standard procedures. In the first session all the patients had brachytherapy in the usual manner with conscious Sedation with parenteral diazepam and pentazocine. For the second and third sessions, they had treatment sessions using conscious sedation and 10% xylocaine spray and a control session using conscious sedation and a placebo spray with 0.9% normal saline (NS) respectively. Visual Analogue Scale (VAS) was used in assessing pain during each of the procedure. Results: Only 80 patients completed the study. Their age ranged from 2870 years with a median age of 54 years. The pretreatment VAS median scores in the treatment and the control sessions were similar at 0.275 and 0.200. However, the postprocedure median VAS scores were increased to 6.3 in the control group and 3.2 in the xylocainetreated group (P < 0.0001). The haemodynamic status including the blood pressure (BP) and pulse rates (PR) were similar pre and post procedure in both groups. Conclusion: Topical xylocaine spray is efficacious in reducing pain and discomfort in HDR Brachytherapy without any appreciable adverse effect."Item Metachronus endometrial carcinoma in a seventy-five-year-old woman with carcinoma of the left breast treated with tamoxifen(2013) Abdus-Salam, A. A.; Moharson-Bello, I. A.; Eriba, L. O.; Abdus-Salam, R. A.Background: A second cancer is a different type of cancer than the original cancer. It is diagnosed after a completed treatment for the first cancer. Second cancers occur in only one to three percent of survivors. The level of risk is very small. In general, greater numbers of cancer survivors are living longer due to improvements in treatment. Whether or not a second cancer develops is dependent on many factors. These include the age of the patient when treated, the treatment received, the genetic make-up and family history. The actual number of people who will get a second cancer is relatively small. Each cancer survivor's experience is unique. The aim of this report is to call attention to what might be an emerging place of secondary malignancies in cancer survivors in our setting. Method: We report a case seen in our practice of a seventy five year old woman who was treated for invasive ductal carcinoma of the left breast and developed invasive endometrial carcinoma about 4 years later. Conclusion: There is a need to be on the lookout for possible second malignancies in cancer survivors. Examination and tests for second malignancies should be part of the routine follow up procedures in this group of patients.Item Histolopathological Patterns of Cervical Carcinoma Seen at A Radiotherapy Centre in Ibadan, Nigeria(2013) Abdus-salam, A.A.,; Eriba, L. O.; Abdus-salam, R. A.; Dawotola, D. A.Introduction: The treatment of cervical carcinoma is dependent on many factors including histological types and degree of differentiation. Degree of differentiation is an important consideration in determining the prognostic outcome. Objective: The study is to describe the histological pattern of cervicer cancer seen in our practice with emphasis on tumour differentiation Method: This retrospective study was carried out within Radiotherapy Department of University College Hospital, Ibadan. The records of patients diagnosed of cervical cancer seen between July 2008 and June 2010 were analysed. Data pulled out included age, disease stage at presentation, histological variant and degree of differentiation. Results: 206 patients were seen during the period of which 196 had complete data. Squamous cell carcinoma (SCC) was seen in 178 patients (i.e. 90.8%) while 14 patients (7.1%) had adenocarcinoma. One patient each had adenoid cystic carcinoma, adenosquamous carcinoma, clear cell carcinoma and mucinous carcinoma. Majority of the patients, 99 (50.5%) had poorly differentiated tumours, 64 (32.7%) had well differentiated tumours, while the rest 33 (16.8%) had moderately differentiated tumours. Of the SCC tumours, 95 (53.4%) were poorly differentiated, 58 (32.6% ) well differentiated while the remaining 25 (14%) were moderately differentiated. In comparison only 3 of the 14 adenocarcinoma cases (21.4%) were poorly differentiated, 5 cases (35.7%) were well differentiated, while 6 (42.9%) were moderately differentiated. The difference in the degree of differentiation between squamous histology and adenocarcinoma was statistically significant (p value=0.002). Conclusion: Poorly differentiated squamous cell. carcinoma remains the leading variants of cervical cancer seen in our environment.Item Advanced carcinoma of the cervix in a 17-year-old girl(2013) Roberts, O.A.,; Owonikoko, K.M.,; Abdus-Salam, A.A.; Ogun, O.Item Evaluation of Serum and Salivary IgG in Head and Neck Squamous Cell Carcinoma(SCIENCEDOMAIN, 2013) Lasisi, T.J.,; Abdus-salam, A.A.,; Lasisi, O.A.,; Akang, EEUAims: To evaluate salivary and serum IgG levels in patients with head and neck squamous cell carcinoma (HNSCC) and healthy control subjects and to assess the effect of treatment on IgG levels.Study Design: A cross sectional study. Place and Duration of Study: Department of Oral Pathology and Department of Radiotherapy, University College Hospital, Ibadan, Nigeria between January 2010 and December 2010. Methodology: Seventy eight subjects comprising 30 patients with untreated HNSCC, 18patients with HNSCC receiving treatment and 30 healthy, age and gender-matched individuals were included. Serum and salivary samples from the participants were analysed for total IgG using ELISA technique. Results: The mean serum IgG in untreated and treated HNSCC patients was significantly lower compared with healthy controls (P=.001), while mean salivary IgG was significantly elevated (P=.001) in untreated HNSCC patients compared with treated and healthy controls. There was no significant correlation between serum and salivary IgG levels. Conclusion: In patients with head and neck squamous cell carcinoma, serum IgG was reduced while salivary IgG was elevated compared with healthy controls. Our finding suggests differential roles of immunoglobulin G in serum and saliva of patients with head and neck squamous cell carcinoma. Hence, salivary IgG may be a useful biomarker in patients with head and neck squamous cell carcinoma, while serum IgG levels may be useful in monitoring treatment in these individuals.Item Pattern of morphine prescription by doctors in a Nigeria tertiary hospital(Wolters Kluwer/Lippincott Williams & Wilkins, 2012) Elumelu, T. N.; Abdus-salam, A. A.; Adenipekun, A. A.; Soyanwo, O. A."Background: Morphine was reintroduced into Nigeria after a long period of absence due to technical problems relating to stock accounting. With this reintroduction, prescriber education was commenced in many centers including the University of Ibadan. Aims and Objective: The aim of this study is to review the morphine prescription habits of the medical doctors practicing at the University College Hospital, Ibadan, and to assess the level of conformity with international guidelines. Materials and Methods: All the prescriptions on oral morphine in the hospital’s pharmacy records within a 6 months period were reviewed. Results: The results showed that more than half (51.7%) of all morphine prescriptions were from the Radiation Oncology Department, while the newly created Day Care Hospice Unit accounted for 31.8% of the prescriptions. No prescriptions were seen from the Labor ward. Only 1.1% of all the prescriptions conformed to international guideline as contained in the “Blue Book.” Conclusion: The results showed that there is a need for more education and advocacy programmes to increase awareness among doctors about morphine prescriptions."Item Evaluation of Serum and Salivary IgG in Head and Neck Squamous Cell Carcinoma(SCIENCEDOMAIN, 2013) Lasisi, T. J.; Abdus-salam, A. A.; Lasisi, O. A.; Akang, E. E. UAims: To evaluate salivary and serum IgG levels in patients with head and neck squamous cell carcinoma (HNSCC) and healthy control subjects and to assess the effect of treatment on IgG levels.Study Design: A cross sectional study. Place and Duration of Study: Department of Oral Pathology and Department of Radiotherapy, University College Hospital, Ibadan, Nigeria between January 2010 and December 2010. Methodology: Seventy eight subjects comprising 30 patients with untreated HNSCC, 18patients with HNSCC receiving treatment and 30 healthy, age and gender-matched individuals were included. Serum and salivary samples from the participants were analysed for total IgG using ELISA technique. Results: The mean serum IgG in untreated and treated HNSCC patients was significantly lower compared with healthy controls (P=.001), while mean salivary IgG was significantly elevated (P=.001) in untreated HNSCC patients compared with treated and healthy controls. There was no significant correlation between serum and salivary IgG levels. Conclusion: In patients with head and neck squamous cell carcinoma, serum IgG was reduced while salivary IgG was elevated compared with healthy controls. Our finding suggests differential roles of immunoglobulin G in serum and saliva of patients with head and neck squamous cell carcinoma. Hence, salivary IgG may be a useful biomarker in patients with head and neck squamous cell carcinoma, while serum IgG levels may be useful in monitoring treatment in these individuals.Item Clinocopathological Features of Renal Cell Carcinoma seen at a Radiotherapy Centre in Ibadan, Nigeria(2012) Abdus-salam, A. A.; Taiwo, T. T.Renal cell carcinoma (RCC) is a rare but lethal disease that accounts for about 2-3% of all adult malignancies. Reports from developing countries indicate a rising incidence while studies in our environment are sparse. The aim of this study is to determine the prevalence, pattern of presentation and outcome of treatment of patients with RCC seen at the Radiotherapy Clinic of the University College Hospital Ibadan. A 25 year retrospective study of patients treated for RCC was conducted. Case file records were retrieved and information on patients’ socio demographic data, presentation pattern, histology, treatment received and outcome of treatment were extracted. A total of twenty four (24) patients were seen within this period. A higher percentage of patients were female (62.5%) while males accounted for only 37.5%. The mean patient age was 42.9 years. Hematuria, loin pain and flank mass accounted for 80%, 37.5% and 28% of the presenting complaints respectively. Only 12.5% of patients presented with the classic triad of hematuria, loin pain and flank mass. Majority of the patients (62.5%) presented with advanced metastatic diseases. The commonest site of metastasis was the spine (29.2%). About two-third (67%) of patients had surgery. All patients had radiotherapy; 50% to the primary sites, 37.5% to metastatic sites and 12.5% to both metastatic and primary sites. All patients who presented with metastasis had chemotherapy. Only 4 patients (17%) were disease-free at the end of the first year post treatment while only 1 was reported dead. The rest were either lost to follow-up (42%) or referred for palliative care (25%) as a result of disease progression. Renal cell carcinoma is a rare malignancy in Nigeria and patients often present late. Physicians working in this region needs to have high index of suspicion to diagnose the disease early as the outcome of treatment in late cases is poor.Item Measurement of Scattered Radiation Dose to the Eyes, Breasts and Gonads of Patients During External Beam Radiation(2011) Elumelu-Kupoluyi, T. N.; Akinlade, B. I.; Abdus-salam, A. A.; Adenipekun, A. A.In Nigeria data on radiation doses to critical organs outside primary radiation beams during radiotherapy is sparse therefore the extent to which other parts of patient’s body are protected during treatment could not be quantified. In clinical studies on measurement of radiation dose to critical structures, even though the doses are relatively low, have been associated with cardiac toxicity and increased risk of secondary cancer. This study is aimed at measuring scattered radiation to the eyes, breasts and gonads, of patients during Cobalt-60 external beam radiotherapy. Thirty patients with malignancy in the abdomen, breast, cervix and head and neck who consented to participate were studied. Scattered radiation was measured with thermoluminescence dosimetry (TLD) using calibrated Lithium Fluoride (LiF) phosphor and TLD Reader, Harshaw 4500. Scattered radiation dose to the eyes, breast and gonads from the treatment fields considered are: Abdomen (0.46 ± 0.10 Gy, 0.52 ± 0.10 Gy and 0.76 ± 0.50 Gy); Breast (0.58 ± 0.10 Gy, 1.10 ± 0.40 Gy and 0.50 ± 0.10 Gy); Head and neck (1.42 ± 1.10 Gy, 0.45 ± 0.10 Gy and 0.49 ± 0.10 Gy); Pelvis (0.50 ± 0.10 Gy, 0.48 ± 0.10 Gy and Nil). Gonads were not measured during irradiation of pelvic region. In this preliminary study, the scattered doses to the critical organs were found to be higher than the radiation level (0.1 Gy) at which cancer risk is considered unlikely. Further study is aimed at exploring treatment approach that would reduce scattered dose to the bearest minimum. [Elumelu-Kupoluyi T. N., Akinlade B. I., Abdus-salam A. A. and Adenipekun A. A. Measurement of Scattered Radiation Dose to The Eyes, Breasts and Gonads of Patients During External Beam Radiation Therapy.Item Pattern of Breast Cancer Metastasis at the Radiotherapy Clinic, Ibadan - A Ten-Year Review(2011) Elumelu, T. N.; Adenipekun, A. A.; Abdus-salam, A. A.; Bojude, A. D.Introduction: - Breast cancer is the commonest cancer among Nigerian women. In Nigeria and indeed Africa and most underdeveloped countries, majority of patients with breast cancer present to the Hospital late with advanced disease. At this stage, the cancer involves the axillary nodes, it may be attached to the underlying muscles and distant metastases are almost certainly present. The primary treatment intent therefore is palliative. Objective: The aim of this study is to determine the pattern of metastasis of breast cancer among patients treated at Radiotherapy Department, University College Hospital, Ibadan. Methodology: Five hundred and eighteen patients with histological diagnosis of breast cancer seen between 2000 and 2009 were studied. Results: There 5 were Males and 513 Females. The mean age was 48.15 years and 63.5% were between the ages of 30 and 50 years. Fifty eight percent of the women were premenopausal while 42% were postmenopausal. The percentage of patients that presented with stages 1, 11, 111 & 1V diseases were 6.2%, 24.7%, 38.8% and 30.3% respectively. The overall incidence of metastasis to distant organs were lung 25.7%, bone 24.1%, liver 7.7%, brain 5.8%, contra lateral breast 0.6% and kidney 0.2%. Conclusion: Based on the data obtained from this study, breast cancer mostly occurred among young women. Compared to earlier studies in Nigeria, breast cancer patients still present late with advanced stage disease with distant metastasis. Baseline bone scan, chest X-ray and abdominopelvic ultrasound scan are recommended for breast cancer patients before commencing treatment to enhance early detection of metastasis. Efforts should be increased towards early detection and treatment.