The objective of this study was to determine prospectively the prevalence of anal complaints amongst Nigerians attending the General Out-patient Department (GOPD) of the hospital and review the records of those admitted to the surgical service with related complications. All the 272 patients attending the GOPD of OOUTH in November, 1999 were interviewed using a structured questionnaire. Information concerning age, sex, educational status, present or past history of at least one of the following symptoms viz recurrent bleeding per rectum, anal prolapse, anal/perianal pain, pruritus ani and anal discharge were obtained. Also obtained were reason(s) for current hospital attendance and any previous medical consultation. Those with at least one of the symptoms were classified as symptomatic. The symptomatic group had rectal examination including proctoscopy. The results showed that 82/272 (30.15% ) were symptomatic. Rectal examination on these 82 patients showed that 10(3.7% of 272) had haemorrhoids, 2(0.7% ) had rectal prolapse, 0.7% had peri-anal warts; 15(5.5% ) anal tags, 10(3.7% ) chronic anal fissure, 2 (0.7% ) perianal fistulae. In 29(10.4% ), the examination was normal and in 12 the rectum was too loaded with feaces to permit proctoscopy. However, only 5/272 (1.84% ) attended the clinic for the anal complaint, while 12(4.4% ) had previously consulted a physician for same. Fear of impotence following surgery in 24 males and belief in herbal remedies in 32 patients were the main reasons for not consulting a physician. During the year 1999, out of a total of 558 admissions into our surgical service, only 4(0.6% ) were for complications related to anal complaints. This study indicated the prevalence of anal complaints in the study population of Nigerians as 30.15% , haemorrhoids constitute 3.7% and anal fissure 3.7% , contrary to low rates reported for developing countries. While this result cannot be extended to represent prevalence amongst Nigerians, it may be a pointer to what is to be expected.

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Results of paternity test, among disputants, carried out in our hospital between May 1992 and May 2002 were analysed. The cases were referred from Social Welfare Office, the Court and the Police. A total of twenty-four (24) cases consisting of 22 (91.7% ) groups of three each, including the disputed child, the mother, and the alleged father; and 2 (8.3% ) groups of four each, with one group consisting of the disputed child, the mother and two alleged fathers, while the other consisting of the mother, the alleged father and the disputed female twins. All the disputed victims were children (10 males and 14 females) in the age group 6 months to 8 years. The total cumulative paternal exclusion rate with our routine techniques was only 16.7% , all with the ABO blood group system. This is a far cry from the exclusion rates of about 97% for HLA testing, and 99.9% for DNA analysis. The available screening package in our hospital is therefore inadequate, and we advocate for the provision of more sophisticated and reliable techniques in designated centres across the country. This will go a long way in resolving the medicolegal and social problems encountered by the disputants and the victims.

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This study was undertaken to provide information on the most probable positions of the mental foramen among northern Nigerian adults. 157 panoramic radiographs randomly selected from patient's records at the Department of Dental Surgery, University of Maiduguri Teaching Hospital and 32 unsexed mandibles from the collection of bones in the Department of Human Anatomy, University of Maiduguri, were examined for the location of the mental foramen. The most common location was the interdental space between the first and second mandibular premolars (radiographs=34% , dry mandibles=32.8% ), closely followed by the position apical to the second premolars (radiographs=25.5% , dry mandibles=35.9% ). No significant difference in the distribution between males and females and the quantitative position was found to be bilaterally symmetrical in most cases. There is almost an equal chance of locating the mental foramen between the mandibular premolars and apical to the mandibular second premolar. This is of clinical importance with regards to the achievement of effective mental nerve block anaesthesia and the prevention of injury to the mental nerve during surgical procedures.

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This is an audit of five years work (1996 - 2001), in oesophageal substitution at the Cardiothoracic Surgery Unit of Lagos University Teaching Hospital, Nigeria. The study aimed at highlighting the current trends in indication and methods of oesophageal substitution in the context of our experience. We did a retrospective study of all who required oesophageal substitution during the period of study. We studied the various aspects of the patients' care including the indications for oesophageal substitution, the substituting organs and the results of surgery. We saw fifty-nine patients comprising 19 patients oesophageal carcinoma, 31 corrosive strictures of the oesophagus, 4 peptic strictures and 3 achalasia cases. Two patients had oesophageal substitution because of mediastinitis. Fifty-five patients underwent oesophageal substitution. The substituting organs were stomachs in 36 patients and colon in 19 patients. There were three anastomotic strictures, two grafts failed, and five cases of anastomotic leaks. In all, operative mortality was 9.1% . We concluded that oesophageal substitution was done more for benign reasons in our centre. We also emphasised the positive aspects of colon interposition and the prospects of doing more of it in the near future.

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AIM: The aim of this article is to review the applications of the buccal fat pad (BFP) in oral reconstruction, 25 years after its first use as a pedicled flap. MATERIALS AND METHODS: A computerized literature search was conducted for articles published from 1977-2002. Mesh phrases used in the search were: buccal fat pad, buccal fat pad and oral reconstruction. RESULTS: A total of 43 articles were selected for the review based on the criteria for the study. Thirty of these articles were clinical articles, 8 were anatomic studies, 2 were review articles, 1 was an experimental study and 2 discussion articles. Only 9 clinical articles were published prior to 1990, and between 1990 and 2002, a total of 21 clinical articles were published. Various application of BFP in oral reconstruction include closure of surgical defects following tumor excision, repair of surgical defects following excision of leukoplakia and submucous fibrosis, closure of primary and secondary palatal clefts, coverage of maxillary and mandibular bone grafts and lining of sinus surface of maxillary sinus bone graft in sinus lift procedure for maxillary augmentation. CONCLUSIONS: The easy mobilisation of the BFP and its excellent blood supply and minimal donor site morbidity makes it an ideal flap. The main advantages of BFP are ease of harvesting, simplicity, versatility, low rate of complications as well as quick surgical technique. The operation can be performed in one incision, affecting neither appearance nor function of the area.

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Erratum in Niger Postgrad Med J. 2004 Dec;11(4):310. Ladapo, IO [corrected to Ladapo, HTO]. To show the continuous investigative value of electroencephalography (EEG) in the management of neuro-pathological disorders such as epilepsy in Nigeria. The limitation against this, especially lack of adequate fund to procure the EEG machine was highlighted. A prospective study over the first twelve months of setting up the EEG unit at the psychiatric hospital, Yaba, Lagos. Subjects included all the patients that had EEG recording in the unit during the study period. Awake EEG was done on each subject using 10-20 system of electrode placement with metal disc electrodes on the 24-channel medelec computerised EEG machine. Majority of the cohort (71.3% ) were aged < 30 years. Seizure disorder constituted the largest clinical reason for EEG request. The EEG findings were normal in close to 44% of the cohort, but abnormal in 56% with 'epileptiform activities' as the most common abnormalities. Despite the notable constraints involved, EEG continues to be of immense value in the management of neuro-pathological disorders in Nigeria.

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OBJECTIVES: The incidence of bradycardia and myocardial depression following halothane induction in children is well documented. Bradycardia leads to reduced cardiac output, which can result in compromised organ perfusion. Halothane may sometimes induce arrhythmia. There is at present no study in this sub-region on the cardiovascular changes of halothane induction in children. This study was designed to investigate the cardiovascular changes and incidence of arrhythmias following halothane induction. PATIENTS AND METHODS: Ninety ASA I - II children aged 6 months to 12 years were studied. Premedication with oral promethazine 1mg/kg was given to all patients above the age of one year. Anaesthesia was achieved with incremental halothane up to 3% in 33% oxygen and nitrous oxide. Halothane induction led to a significant drop in SBP, DBP and MAP in all patients at the end of induction. (p < 0.005). Heart rate values were significantly less postinduction in children older than one year (p < 0.05). Arrhythmias occurred in 3.3% of all patients. No patient experienced bradycardia. Other complications included hypotension (8.8% ) and mild laryngeal spasm (2.2% ). RESULTS: Halothane induction in children results in significant reduction in heart rate and blood pressure. Bradyarrhthmias are uncommon with promethazine premedication.

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In order to assess the reported efficacy of natural honey in the healing of chronic ulcers, the efficacy of locally applied natural honey was compared to that of Eusol solution in an open trial involving 20 patients with sickle cell anaemia (SS) who were in steady clinical states and had chronic leg ulceration. All patients were admitted to hospital for the 4 week duration of the trial for bed rest, daily aseptic dressings, and weekly measurement of the size of the ulcer. Fifteen patients with a total of 19 leg ulcers were evaluable at the end of the trial. Eleven ulcers were dressed with honey while 8 were dressed with Eusol. No significant differences were found in rates of healing of the ulcers in either treatment groups. This trial does not support the suggestion that natural honey is superior to Eusol in the healing of chronic sickle cell leg ulceration.

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Reliable and accurate data remain scarce on the cause and rates of mortality among adults in sub-Saharan Africa. The Idikan Adult Mortality Study, a prospective community-based study was initiated in order to obtain the overall as well as cause-specific mortality data for a community of adults (15 years and above). Standardised verbal autopsy questionnaire was used to investigate and assign the mode and cause of death. There were 232 reported deaths in the baseline population of 4127 adults over 5 years, giving an unadjusted death rate of 11.2 per 1000 per year. Thirty-nine (16.8% ) of these death occurred suddenly. The commonest known cause of death was due to cardiovascular disease, which was responsible for 43 (18.5% ) of all deaths. It was also the commonest known cause of sudden death accounting for 30.8% of such deaths. Infection was responsible for 28 (12.1% ) deaths while injury accounted for 7 (2.6% ) deaths. Subjects, 50 years and above were more likely to die and also die suddenly than were the younger subject (p<0.0001, p<0.0001) and significantly more death occurred in males than females (6.9% versus 4.7% ) (P<0.01). Deaths were also more likely to have occurred at home and outside the hospital, increasing the probability of these deaths being underreported. Following multivariate logistic regression analysis, respondents between the age of 20 -49 years had significantly reduced risk of dying (p=0.029), while cigarette smoking significantly increased the risk of dying (p=0.012). In the absence of the urgently needed vital statistics, use of verbal autopsies is a potentially useful investigative method for identifying and assigning cause of adult deaths in a community.

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OBJECTIVE: to review cases of myasthenia gravis at the Lagos University Teaching Hospital. METHODS: features of 27 cases of myasthenia gravis seen at the Neurology outpatient clinic of the Lagos University Teaching Hospital between January 1995 and December 2000 were reviewed using a uniform protocol. RESULTS: peak age incidence was in the third decade, and the male to female ratio 1.7 to 1. The commonest presentation was ptosis (85.1% ), followed by diplopia (37% ) and limb weakness (37% ). Other features such as dysphonia, dysphagia and dysarthria, were relatively uncommon. Ocular myasthenia gravis was diagnosed in half of the patients and generalised myasthenia in the other half. All the patients except four responded satisfactorily to prednisolone and/or anti-cholinesterase. Azathioprine was added to the treatment of those that did not respond well, and replaced prednisolone in a patient who developed steroid-induced diabetes mellitus. One patient developed myasthenic crisis and required artificial ventilator support. One patient had thymectomy. CONCLUSION: cases of myasthenia gravis present infrequently at the neurology clinic of the Lagos University Teaching Hospital. Clinical presentation and response to treatment are similar to those described elsewhere.

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This report illustrates the rare association of Holt-Oram syndrome with hypoplastic left heart syndrome hitherto unreported in an African child. The above association is highlighted as this child and the only other case reported in a Caucasian were diagnosed post mortem. The need for early cardiovascular and genetic evaluation or simple detailed family history to aid counselling is also emphasised.

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From January 1992 to December 1996, a total number of 1887 new cancer cases were registered at the hospital-based cancer registry (CR) of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. There were 878 (46.6% ) males and 1008 (53.4% ) females with male to female ratio M:F 1:1.12. Malignant lymphoma, 198 (22.5% ) was the commonest cancer in men. This was followed by carcinoma of the urinary bladder, 103 (11.7% ) and prostate, 81 (9.2% ). In women cancer of the cervix, 256 (25.35), breast 223 (22.1% ) and malignant lymphoma, 72 (3.1% ) were the commonest in that order. All the four new cases of cancer of the lung occurred in men. Brain tumour is rare and occurred during childhood. Data were collected from various sources within the hospital complex through active reporting. International classification of disease (ICD) 9th edition by WHO was utilised in the classification of primary sites of cancer. Cancer, a non-communicable disease is increasingly becoming a major public health concern, hence the need for a national policy formulation for its management and control.

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Sickle cell disease has varied manifestations in all systems of the body, ocular manifestations can be severe and sudden blindness may result amidst other complications. The study aims at determining the ocular findings in patients with sickle cell anaemia (HbSS) and sickle cell haemoglobin C disease (HbSC). 99 subjects were recruited into the study carried out at the Lagos University Teaching Hospital over a 2 year period. A structured interview questionnaire was administered and physical examination was carried out at the Medical Out Patients' Sickle Cell Clinics. Subsequently in the (Guinness) Eye centre, examination for ocular manifestations was carried out using Snellen's chart, Slit light microscopy, direct and indirect ophthalmoscopy under mydriasis (with Gutt Tropicamide 1% , epinephrine 10% ) as well as tonometry and gonioscopy. The age of the 99 (51 males, 48 females) patients ranged from 13 to 43 years with a mean +/-SD of 20.42 +/- 6.13. There were 88 (88.9% ) SS and 11 (11.1% ) SC patients. The male to female ratio was 1.1: 1. Normal vision was present in 95 (96% ) of the patients [86 (97.8% ) SS and 9 (81.8% ) SC] while 4 (4.0% ) of the patients [2 (2.2% ) SS and 2 (18.2% ) SC] had impaired vision. Of the complaints, blurred vision was found in 12 (13.6% ) SS and one (9.0% ) SC patients. Itching of the eyes was found in 15 (17.0% ) SS and 3 (27.3% ) SC patients. Icterus was found in 50 (50.5% ), conjunctival signs were found in 49 (49.5% ), retinal vascular tortuosity was in 12 (12 .10% ), peripheral retinal degeneration was in 5 (5% ), iridescent spots was in 3 (3% ) and optic atrophy in 2 (2% ) patients. The tortuosity of major fundus vessels were graded into 4 according to Hook and Cooper's criteria 87 (87.9% ) of the patients were in grade 0. The conjunctival vessels anomalies were classified into 5 grades (criteria of Sergeant). 37 (37.5% ) were in grade 0, 35 (35.3% ) in grade 1, 8 (8.1% ) in grade 2, 7 (7.1% ) in grade 3 and 12 (12.1% ) in grade 4. Conjunctival abnormalities occur commonly while proliferative retinopathy and optic atrophy were uncommon in sickle cell disease patients in Lagos. Further studies are required with a larger number of subjects to investigate the low incidence of proliferative retinopathy and optic atrophy in Lagos.

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Melorheostosis of Leri is a non-familial condition of hyperostosis of the cortical bone that usually presents unilaterally in long bones of the upper and lower limbs, but may also present in vertebra, ribs, skull and jaw. The incidence of this disease is quite rare, only about 300 cases have been reported worldwide. We present a case, which may be the first documented case in sub-Saharan Africa. CLINICAL PRESENTATION: S.K. is a 14 year old male student who presented to the hospital with an 18 month history of persistent pain in the joints of the right upper limb and a limb length discrepancy since birth which has worsened with growth. Examination revealed generalised hypoplasia of the right upper limb with shortening of the limb and atrophy of the muscles, also hypoplasia and contracture of the thumb was observed. The radiographs of the limb showed multiple areas of dense hyperostosis and scleroderma, which showed a linear distribution along the radial half of the bones. CONCLUSION: In children presentation of melorheostosis, is more likely be as limb length discrepancy, deformity or joint contractures which may be seen before radiographic evidence of any bony changes. Improvement in imaging techniques will therefore result in early diagnosis and greater success with conservative management. Also the increased frequency of tumours necessitates long-term follow up.

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The aim of this study was to assess the prevalence of halitosis among periodontal patients and to evaluate the association between this condition and increasing age, social class, gender and oral hygiene status. The subjects comprised two hundred and fifty five consecutive patients who attended the periodontology clinic of the University College Hospital from November 1996 and March 1997. The patients were matched for sex and their ages ranged from 16 years to 74 years and made up of 128 males and 127 females. Cases of halitosis were cross-validated by two examiners to rule out a biased diagnosis. One hundred and twenty eight patients were males while 127 were females. A total of 37 patients presented with halitosis representing 14.5% . There was no statistically significant difference in relation to gender, p > 0.05. In the different age groups, only 7% of the subjects in the 31 - 40 years age group had halitosis while 36% of the subjects in the over 60 years age group were affected, (chi(2) - 13.01, df = 5, p < 0.05). There was also a statistically significant difference in the prevalence of halitosis according to oral hygiene status and social class. The results showed a low prevalence of halitosis as erroneously claimed but showed an association between the condition and increasing age, social class and oral hygiene status.

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BACKGROUND: Tetanus, an ubiquitous disease still ravages our population despite the fact that it is totally preventable. The mortality had remained high with its attendant socio-economic implications as it affects mainly farmers in their prime of life. We conducted this retrospective review to be able to determine pattern of presentation, case fatality rate and factors influencing mortality with a view to mapping out control strategies. PATIENTS, MATERIALS AND METHODS: The case records of all managed patients aged 16 and above over a ten-year period (1992-2001) were retrieved and socio-demographic and clinical data as well as results of laboratory investigations were collated. Analysis was done using SPSS package. Chi-square analysis and student t-test were used for comparison of means as appropriate. P-values of <0.05 were taken as significant. RESULTS: There were a total of 114 patients managed during the period, which comprised 85 males and 29 females. The mean age (+/- SD) was 35.96 years (+/- 17.76). Sixty-six (57.89% ) patients are either jobless or farmers. Majority of the patients had injuries in the lower limb (59.65% ) when compared with 20.18% that had theirs in the upper limb. 107 (93.86% ) of the patients presented with trismus while only 82 (71.93% ) had opsthotomus. Only 51 (44.73% ) patients survived while 61(53.5% ) died. The mean age (+/- SD) of the survivors was 32.35 (+ 14.45) years while that of those that died was 39.4 (+/- 19.89) years (P = 0.036). Other factors that significantly influenced survival included severity of spasms (P = 0.003), tachycardia (P = 0.044), and degree of sedation (P<0.0001). No association was found between survival and incubation period, period of onset, site of injury and associated medical conditions. CONCLUSIONS: Tetanus is still associated with high mortality rate. Factors such as severity of spasms, age, sedation and tachycardia were found to significantly influence mortality. It is recommended that prophylactic life immunisation against tetanus be given to all Nigerians.

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