Biomedical subjects
Publications and source records attributed to J O Obafunwa.
An adolescent boy who was being treated for psychiatric illness went missing. The body was discovered a year later, and he appeared to have committed suicide by inhaling the exhaust fumes from his motorbike. This report highlights the procedure used for the identification of his skeletonized body and the unusual nature of the source of exhaust fumes.
CD44 and its variant isoforms are a group of transmembrane glycoproteins which play important roles in immune recognition, in lymphocyte trafficking, and in cell-cell and cell-matrix interactions. Although CD44 is expressed by some normal human epithelial and mesenchymal cells, upregulation of CD44 expression has been related to the metastatic potential of some malignant tumours. In this study of 27 hepatocellular carcinomas (HCCs), an indirect immunohistochemical method was used to investigate the distribution of CD44 in normal liver and to determine whether expression of the standard form of CD44 (CD44s), or two of its variant isoforms (CD44-v3 and CD44-v6), correlated with tumour grade, proliferation indices, or histological evidence of vascular invasion. Fifteen of the tumours were Edmondson grade II, four were grade III, and eight were grade IV. Liver cell dysplasia was present in adjacent liver parenchyma in three cases and vascular invasion was observed in ten HCCs. Vascular invasion was found to be more frequent in high grade HCCs and a significant correlation was observed between tumour proliferation indices and vascular invasion. CD44s was not expressed by epithelial cells of normal liver but was expressed by tumour cells in six HCCs; vascular invasion was present in five of these HCCs. Three CD44s-positive cases also expressed CD44-v3 and two of these also expressed CD44-v6. CD44 was not expressed in areas of hepatocyte dysplasia. There was a significant correlation between CD44 expression and the presence of vascular invasion, but not between CD44 expression and tumour grade or tumour proliferation indices. It is concluded that upregulation of cell surface CD44 expression on malignant hepatocytes is related to their tendency to vascular invasion and may have implications relating to metastasis and prognosis in patients with HCCs.
A review of 400 completed suicides encountered during a 5-year period (January 1987-December 1991) in the Lothian and Borders Region of Scotland (LBRS) was conducted. The incidence was 9.4 per 100,000 with a M:F ratio of 2.4:1; the elderly had a significantly higher (P < 0.001) rate (9.9 per 100,000) compared to adolescents (3.3 per 100,000). Significantly (P < 0.001) more cases occurred in the rural communities. Overall, the peak incidence was in the 45- to 54-year age group. Drug overdose was the most common (39%) method used by both sexes and in both urban and rural communities; it was the first choice for virtually all age groups, and females exhibited greater preference. Analgesics and tricyclic antidepressants were the most common drugs used. Hanging (19.8%) was popular among the young and the elderly (> 64 years) suicides. Inhalation of car exhaust (13.3%) was a rural phenomenon and was common in the 25- to 54-year age group. Jumping from heights (9.8%) was more common in the urban areas; an increasing trend in the use of this method by females was possibly emerging. Drowning (8.3%) exhibited no particular pattern and the use of firearms was relatively uncommon (2.8%). This study and any subsequent assessment of socio-medical factors associated with completed suicide in this region should provide a basis for the formulation of preventive strategies. A continuous monitoring of the trends in the LBRS is necessary.
A total of 48 cases of dextropropoxyphene-related deaths that occurred over a 6-year period (1987-1992) in the Lothian and Borders region of Scotland were reviewed. No significant gender difference was found but a significantly greater proportion of the deaths occurred in the urban areas (P < 0.05). Suicide accounted for 81.3% of cases while the other deaths were caused accidentally and involved drug addicts, alcoholics and those who had taken their dextropropoxyphene-containing prescriptions following consumption of alcohol. Overall concomitant alcohol abuse was identified in 41.7% of all the victims. Compound analgesic preparations containing dextropropoxyphene are still widely prescribed and the persistence of deaths from its overdose may suggest the need for stricter prescription control and for educational programmes for users.
Of the 400 consecutive completed suicides investigated over a 5-year period, 114 (28.5%) who had consulted a doctor in the week preceding death were specifically reviewed and compared with those who did not. The study comprised an analysis of the medical history, the scene of death and a complete autopsy with histological and toxicological examination and the identification of features which occurred more frequently in this group when compared with other suicides not contacting their doctors. Suicide-associated factors include psychiatric illness (58.8%), deteriorating health (16.7%), and a loss of spouse (7.0%); all these features were manifested by this group of suicides more frequently than by those who made no clinical contact (P < 0.001). A pre-indication of suicidal intention was made by 45% of these patients. This feature, as with previous attempts, occurred more commonly in patients who consulted a doctor (P < 0.001). Drug overdose was the most common suicidal method chosen (50.9%) and anti-depressants predominated (35%); 78% of those who overdosed ingested prescribed drugs. Poisoning was more common in this group (P < 0.001). Half of the victims committed suicide within 24 hours following consultation; of these, 51% overdosed on drugs with 61% of them ingesting their prescribed drugs. Of these 114 cases, the final consultation in 43% was to collect more drugs. All suicidal threats should be taken seriously, and particular care should be taken in prescribing and dispensing medication which may be fatal in overdose.
Four scuba diving deaths investigated by the Forensic Medicine Unit, University of Edinburgh Medical School, are reported. The pathological investigation of such deaths requires that a detailed history of the events prior to death is obtained and that the site of the accident is fully examined with underwater photographic recording where possible. The diving suits, breathing apparatus and other diving accessories also have to be examined carefully by experts and a complete autopsy with toxicological and histological examination is essential. The causes and mechanisms of death are discussed, as are the importance of special autopsy techniques and investigations. Possible interpretative problems are highlighted.
Two cases of suicidal chloroquine poisoning are presented. The autopsy, toxicological findings and strategies for preventing self-destruction by this method are discussed.
1. A retrospective analysis of 352 consecutive cases of fatal substance overdose that occurred in the Lothian and Borders region of Scotland (LBRS) between 1983 and 1992 (inclusive) is presented. All these cases were subjected to a full forensic autopsy with histological and toxicological studies. 2. The overall male:female ratio is 1.2:1. Males significantly predominate (1.9:1) in the 21-30 year age group, but females significantly predominate (0.7-0.9:1) above the age of 50 years (P < 0.001). A significant progressive alteration in the sex ratio is noted: from 0.7:1 in 1988 to 2.4:1 in 1992 (P < 0.001). 3. Analgesics account for 43.2% of all overdose deaths with narcotic analgesics representing 32.4%. Dextropropoxyphene is the commonest (38.2%) narcotic analgesic and fatal overdoses on it have been increasing since 1989; methadone deaths also showed an increase. Death from heroin overdose fell sharply in 1985. 4. Antidepressants account for 20.2% of deaths (tricyclics representing 19.3%): Amitriptyline is the commonest (75.0%) tricyclic and its use, particularly by female suicides, has been increasing since 1989. Barbiturate poisoning has declined considerably since 1986. 5. Temazepam comprises 65.4% of all benzodiazepines overdose deaths; two-thirds of fatal benzodiazepine abuse involve males. 6. This study once more emphasises that physicians, and especially general practitioners, must prescribe cautiously for their patients. Control through legislation of the sale of non-narcotic analgesics is worth serious consideration.
1. A 6-year retrospective study of the features of 79 consecutive completed suicides from exhaust fume inhalation (SEFI) in the Lothian and Borders region of Scotland was conducted. Full forensic autopsies with histological and toxicological studies were carried out. 2. The mean incidence is 2.0/100,000 population (M = 3.7; F = 0.4; P <> 0.001); increasing since 1990. The age peak is in the 35-44 years age group (especially among males) and a significant (P < 0.001) proportion reside in rural areas. 3. SEFI is significantly (P < 0.05) higher during spring and summer; outdoor locations are prevalent during summer. 4. Most (75.6%) of the victims were in current employment. Psychiatric illness (30.7%), problems in marriage or relationships (28.2%) and financial difficulties (16.7%) were the major associated socio-medical factors. 5. The mean carboxyhaemoglobin (COHb) saturation was 74 +/- 11.2%; fatal COHb saturation levels were still detectable in severely decomposed bodies. The blood alcohol concentration (BAC) in 37 of the victims ranged from 14-397 mg dl-1. No significant correlation exists between COHb saturation and the victim's age or BAC. 6. Attempts to reduce the incidence of SEFI must be directed principally to dealing with associated sociomedical problems. The reduction of the potential of vehicles to produce carbon monoxide and of directing exhaust fumes into the interior of the vehicle are important secondary preventative measures.
A 12-year-old girl fatally suspended herself accidentally from a tree branch with a circumferential webbing tape tied round the midtrunk area. This occurred as part of a recreational practice whereby the body, tied in this fashion, could be made to swing in a pendulumlike horizontal plane. She was found dead in this position, hanging transversely one foot above the ground. A complete autopsy showed a tram-line circumferential parchmented bruise of the midtrunk area and bruising of the intercostal muscles and diaphragm with occasional petechiae. The mechanism through which death resulted in this case is believed to have involved a progressive tightening and compression of the primary respiratory muscles, resulting in eventual failure of the respiratory effort.
A total of 102 autopsy subjects found to have seemingly normal testicular picture were analysed to determine acceptable normal morphometric values. The mean tubular diameter in the last trimester of intrauterined life is 43.8 mu in contrast to adult value of 173.0 mu. The mean basement membrane thickness increases from 3.2 mu in the last trimester to 6.9 mu in the 10-14 years age range. The adult mean testicular score count is 19.3 in contrast to 5.3 observed in the last trimester. While Sertoli cells predominate in the last trimester of intrauterine life, many spermatozoa are seen during the period 15-19 years.
One hundred and seventy-seven men who had testicular biopsies done for infertility investigations over a 5-year period (1983-1987) were studied. Twenty per cent had normal histological pictures. Varying degrees of hypospermatogenesis were seen in 49% while 19% had chronic non-specific orchitis. The remaining 12% had various other pathological changes.
A death of an amateur SCUBA diver with undiagnosed late phase endomyocardial fibrosis is reported. This 27-year-old man found himself in difficulties during a Sub-Aqua Club outing and drowned. Autopsy revealed features of drowning in addition to severe endomyocardial fibrosis (EMF) with collagenization of the left ventricle and interventricular septum with foci of chronic myocarditis. Other organs were essentially normal and toxicological studies were negative. Examination of the air tank revealed a normal oxygen circulation with elevation of the carbon dioxide content above recommended limits. Sudden ventricular arrhythmia underwater due to EMF is believed to have precipitated drowning. Stricter medical monitoring of amateur divers should prevent similar accidents in the future.
Surgeons in developing countries see a need to improve diagnosis and decision making in patients with an acute abdomen. Without the benefit of diagnostic aids such as computers and high-resolution ultrasonography, the rate of unnecessary laparotomy is often unacceptably high. The laparoscope is usually available in a developing country and its use easily acquired. Using laparoscopy in doubtful situations the unnecessary laparotomy rate was significantly reduced from 14.0 to 6 per cent (P < 0.05). Laparoscopy achieved a diagnostic accuracy of 86 per cent and prevented unnecessary laparotomy in 57 per cent of those in whom it was used.
An 18-year-old Nigerian girl died suddenly and unexpectedly from disseminated porocephalosis. The patient was hospitalised complaining of fever, dizziness, weakness and jaundice. Clinical examination revealed a restless, confused and hypotensive patient. She died within two hours of admission. Autopsy revealed disseminated Porocephalus armilatus infestation involving the thoracic and abdominal linings and their internal organs. The relationship between the disseminated parasitic involvement and the death of this girl is discussed.
One hundred-and-sixty-seven cases of malignant lymphomas (ML) diagnosed in the Jos University Teaching Hospital, Jos, Nigeria, over a ten-year period (1979-88) were reviewed. The overall incidence rate is 13.4 per 100,000 with a median age of 29 years and a male:female ratio of 3:1. Non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) represent 67.7 pc and 32.3 pc cases respectively. Low, intermediate and high grade NHLs account for 51.4 pc, 17.7 pc and 30.0 pc of cases respectively; the collective median age at presentation is 31 years and the male:female ratio is 2:1 (Follicular: 13.3 pc; diffuse 86.7 pc). The small lymphocytic lymphoma is the commonest NHL (38.1 pc); the small non-cleaved cell type (African Burkitt's lymphoma type) accounts for 24.7 pc with an incidence rate of 2.2 per 100,000 within the general population and a median age of 10 years. Hodgkin's disease (median age: 28 years) is the commonest form of ML exhibiting only a single peak in the 21-30 years range. The male:female ratio is 8:1 and histological types associated with poor prognosis predominate. The prevalent clinical presentations is with a painless peripheral lymphadenopathy, the cervical group of lymph nodes is often involved representing 55 pc and 67 pc of NHL and HD cases respectively. Burkitt's lymphoma present primarily as an abdomino-pelvic tumour (67.8 pc of cases). Primary extradonal presentation is seen in 90 pc of MLs, all of which are the NHL group with Burkitt's lymphoma accounting for 80 pc of all cases.
Forty eight needle biopsies of the liver, from children registered in the histopathological laboratory of Jos University Teaching Hospital (JUTH) were reviewed. Liver disease diagnosis was based on histopathological criteria without recourse to either clinical, biochemical or microbiological data. Hepatic Schistosomiasis (37.5%) and liver cirrhosis (25%) were the most frequently diagnosed lesions. There were only two cases of biliary cirrhosis secondary to biliary atrisia. Parasitic infestation of the liver was the most common cause of childhood hepatic dysfunction. Our results confirm the observations of workers in other tropical and subtropical regions, where infection is the commonest cause of childhood liver disease. This is in sharp contrast to the findings from European countries where neonatal hepatitis or biliary atresia are the most commonly diagnosed disorders. This retrospective study provides a good starting point for a prospective study, to determine the incidence and severity of childhood liver disease in Nigeria. This is a retrospective histopathological study aimed at establishing the pattern of liver disease in the paediatric age group in Jos. The indication for liver biopsy in all the cases was hepatosplenomegaly with or without biochemical abnormality.