OBJECTIVE: To compare post operative complications, rates of wound healing, and cost effectiveness between the closed and open methods of haemorrhoidectomy. DESIGN: Prospective. SETTING: Jos University Teaching Hospital (JUTH), Jos and Evangel Hospital, Jos. PATIENTS AND METHODS: Consecutive patients who presented with second and third degree haemorrhoids were randomised into an open group A and a closed group B. Time taken for wound to heal, the postoperative complications and cost of management in each group were assessed. Each patient was followed up for at least three months. RESULTS: There were 59 males and 20 females, distributed between group A (n=39) and B (n=40). The average postoperative hospital stay was 5 days in group A and 3 days in group A. There were no differences in the complication rate between the two groups. Post operative retention of urine was the commonest complication and occurred in 12 patients: 7 in group A and 5 group B. This was followed by reactionary haemorrhage in 6. All of which occurred in group A. There were 8 patients with skin tags: 5 in group A and 3 in group B. Other complications included secondary haemorrhage (2), wound dehiscence (4) and wound infection (2), all in group B. The average wound healing time was significantly shorter in group B (2.8 vs 5.0 weeks). The financial difference between the two treatment groups was not statistically significant (N4,593.00 and N4,598.00, or 34.02 dollars and 34.06 dollars in groups A and B, respectively). CONCLUSION: The cost per patient and morbidity did not show any statistically significant differences between the open and closed methods of haemorrhoidectomy. However, healing was significantly faster in group B.

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OBJECTIVE: To evaluate the clinical features and stage of chronic liver disease at presentation in Lagos. METHODS: Clinical features, hepatic functional reserve (Child-Pugh classification) and liver histopathology were evaluated in 74 patients with chronic liver disease (CLD). RESULTS: The average age of the patients was 44.1 +/- 14yr and most (57, 67% ) were male. Ascites, hepatomegaly and jaundice were noted in 66%, 51%, 47% respectively. Hepatocellular carcinoma, liver cirrhosis and chronic hepatitis were seen in 35, 29, and 10 patients respectively. Significant impairment of hepatic functional reserve was noted in most of the patients with liver cirrhosis (76% ) and carcinoma (68% ). Hepatitis B and C infections were identified in 58% and 12% of the patients respectively. CONCLUSION: The majority of clinically identified patients with CLD had severe impairment of hepatic function with underlying advanced liver cirrhosis or hepatocellular carcinoma at presentation. Viral hepatitis was associated with most CLD and thus is potentially preventable and treatable when detected early. Public enlightenment programmes on hepatitis, widespread implementation of HBV vaccination, and surveillance of individual at-risk are essential for the control of hepatitis infection and the early detection of compensated CLD.

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Goiter is endemic in some parts of Nigeria. Kano is populated by people from various geographical areas. There has not been any report of thyroid gland diseases pattern in Kano, hence the need for this study. A retrospective review of 75 cases of thyroid gland diseases seen and managed at Aminu Kano Teaching hospital, Kano over a 5-year period forms the basis for this study. Of the 75 patients with goiters 69(92% ) were females. Simple non-toxic goiter was the most common histologic type accounting for 51 (68.0% ) of cases. There were 10 cases (13.3% ) of thyrotoxicosis, 4 (5.4% )with follicular adenoma, and 10 (13.3% ) other patients had proven carcinoma. Well-differentiated follicular carcinoma was the most common malignant type, 7 of which were not recognised as such preoperatively. All cases were treated by surgery with minimal morbidity and mortality. Thyroid surgery constitutes a significant proportion of surgical practice in Nigeria. While increase in dietary iodine will reduce the incidence of goiter everywhere, the impact of iodinisation of salt is yet to be determined. A population based survey of the prevalence of thyroid gland disease in Kano northwest, Nigeria is strongly indicated.

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A review of type 1 Tympanoplasty operations (myringoplasty) done on thirty (30) ears in the University of Benin Teachinhg Hospital, Benin City, (UBTH) during a ten - year period was carried out. The patients were aged 21 to 69 years, and consisted of 21 males and 9 females. 15 (50% ) of the ears had medium to large sized central perforations whilst 13 (43.3 % ) were subtotal perforations. Two cases (6.6% ) had marginal perforations. The overall success rate in terms of full graft take was 66.6%, whilst 32.3 % had partial take of the graft. Post operative audiograms showed improvement in hearing in 77% of those cases for which records were available. However long term outcome both for graft take and hearing improvement was impossible to establish due to poor follow-up compliance in the majority of patients. Although there are many cases of chronic suppurative otitis media (CSOM) with resultant persistent tympanic (TM) perforation and concomitant hearing defect in the community, the relutance or inability of patients to have reconstructive ear surgery, relative lack of the facilities for the operation in our hospitals and poor follow-up compliance amongst our patients are some of the identificable problems related to this otherwise worthwhile procedure.

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Pure red cell Aplasia (PRCA) is a transfusion dependent condition characterised by anaemia, reticulocytopaenia and a paucity of erythroid precursors in the bone marrow. Records of patients with PRCA seen in Ahmadu Bello University Teaching Hospitals between 1991 and 2001 were reviewed and the outcome of their management was assessed. Fifty per cent of the ten patients had high dose methyl Prednisolone (HDMP) therapy. Seven patients recovered, 2 died and one was lost to follow up. All patients had red cell concentrate transfusion

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Age is often a marker for co-morbid illness that may complicate attempts at surgery, hence careful preoperative assessment and vigorous treatment of the pre-operative medical condition with adequate post-operative supports are needed for safe surgery. In our series, a fifteen months study period, six hundred and Ninety five patients were operated upon out of which forty four patients were 65 years old and above (6.3% ); Age ranged between 65 years and 80 years (mean age of 70 years). The patients with medical problems were sixteen (36.4% ) out of which urinary tract infection was the most common (43.8% ). The most common anaesthetic technique was spinal anaesthesia in 45.5%, the most common operative procedure was herniorrhaphy (36.4% ); followed by prostatectomy (26.5% ). Three of the patients presented with wound infection; mortality was 2.3%, which occurred in a patient who died of multiple organ failure.

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Fifty five (55) patients consecutively booked for major elective surgery were assessed pre-operatively for minor psychiatric symptoms and baseline anxiety levels using the GHQ - 30 and the state version of the state - Trait Anxiety inventory (STAI). Measurements of post-operative anxiety levels were also done for the seven consecutive post-operative days using the STAl. The prevalence of minor psychiatric morbidity was 38%. Patients who were GHQ - 30 cases had higher pre-operative and post-operative anxiety levels than those who were not GHQ- 30 cases. Mean baseline pre-operative anxiety levels were not achieved even on the seventh post-operative day. Pre-operative and post-operative psychological interventions may have useful clinical implications for the anesthesiologist surgeon and psychiatrist as they may need to pay special attention to those identified as being at a greater risk for pre and post-operative anxiety.

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OBJECTIVES: To determine the relative frequencies of malignant disease of the female genital tract. DESIGN: A retrospective review of histopathology report. SETTING: University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. SUBJECTS: Women who had gynaecologic cancers. RESULTS: The cervix was the commonest site of malignant disease (63.1% ) followed by the endometrium, ovary, vulva and vagina. The age of the patients varied with the type of cancer as follows - endometrium (54.8 years), cervix (51.9 years), ovary (40.4 years), choriocarcinoma (30.6 years). CONCLUSION: There is an urgent need to establish a national community - based cervical cytology service to reduce the incidence of cervical cancer and its attendant morbidity and mortality.

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This is an analysis of the effects of prognosticating factors on the outcome of patients with tetanus who were seen in our hospital between 1990 and 2000. Tetanus remains a major public health hazard associated with high mortality. A total of 66 cases were analysed with a slight female preponderance. The mortality rate was 26.2% with an age-adjusted fatality rate of 16.2% for those under 40 years of age. This increased to 75% for those patients above 70 years of age. The most common portal of entry was lower limb, specifically the foot, and this was the case in 56%. The socio-economic status of the patients, the immunisation status, the incubation period, the age of the patient, the severity of the spasms, the duration of hospital stay, the type of treatment received and the onset time were found to affect the outcome of the patients. We recommend that health care providers should take every opportunity to review the vaccination status of their parents and provide tetanus vaccine when indicated, and recall when treating injured patients that many middle-aged and older adults are not adequately immunised against tetanus.

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OBJECTIVE: To describe acute cerebellar ataxia seen in Nigeria patients with acute falciparum malaria. PATIENTS, METHODS AND RESULTS: We report 5 patients seen at the Lagos University Teaching Hospital (LUTH) over a 3-year period with cerebellar ataxia (CA) following proven/presumed acute falciparum malaria. Two of them are children. The youngest is a 7-year-old girl and to our knowledge is the youngest child in which the syndrome has been reported. The mode of presentation is similar to that of patients previously reported with the syndrome from other parts of the world. the minimum duration of ataxia was 2 weeks, while the maximum duration was 6 weeks. All patients received prednisolone for the total duration of symptoms and there was complete resolution of ataxia in them all. CONCLUSION: We suggest that CA associated with acute malaria occurs in Nigerians and that the features are similar to those described from other parts of the world. In comparison with cerebral malaria, this neurological complication of falciparum malaria has a good prognosis, resolving completely in virtually all cases. There is therefore the need to be on the look out for it, in order to appropriately counsel patients.

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The significance of the Modified Allen's Test has not been determined in Nigerians who need forearm arterio-venous fistulae. We sought to determine this in thirty-four patients who needed forearm arterio-venous fistulae for haemodialysis. Side-to-end radio-cephalic arterio-venous fistulae were successfully created on their forearms notwithstanding the result of Modified Allen's test. Modified Allen's test was negative in 12 (35.3% ) of the patients and side-to-end radio-cephalic fistulae were created on the forearm of all of them without any untoward effects. We concluded that preoperative Modified Allen's test is not necessary for side-to-end radio-cephalic arterio-venous fistulae of the forearm.

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OBJECTIVE: To evaluate the effect of an educational intervention on rational drug use amongst Primary Health Care workers in two Local Government Areas (LGAs), Mushin and Ikeja, in Lagos State. METHODS: Mushin was randomly selected as the intervention LGA while Ikeja was selected as the control L.G.A. A structured educational intervention designed to improve prescribing practices was carried in Mushin LGA for four weeks. Drug use indicators were measured before, at two weeks and three months post intervention. RESULTS: At baseline, most of the drug-use indicators in the intervention LGA were significantly worse (p < 0.05) than the control LGA. However, at the two-week evaluation, the educational programme achieved a significant reduction in the average number of drugs in the intervention LGA from 7.3+ 2.8 to 6.3 + 2.3 (p=0.000) compared to the control LGA where there was no significant change (from 4.9+ to 4.8+2.2, p=0.647). There was also a significant increase in the percentage of patients rationally managed from 18% to 30% (p=0.0005) in the intervention LGA unlike the control LGA (from 33% to 31%,p=0.693.). The rate of change in the average number of drugs prescribed was significantly higher in the intervention LGA (+14% )compared to the control LGA (+2%,p=0.0000). The improvements were not sustained at the three-month evaluation, as most of the indicators were similar to values obtained at the baseline. CONCLUSION: The intervention programme significantly improved rational drug use in the short-term period only. Other cost effective and sustainable intervention models for improving prescribing practices should be developed.

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OBJECTIVE: To assess the knowledge of HIV/AIDS among Nigeria undergraduates and to determine how the knowledge has influenced their sexual behaviour. MATERIALS AND METHODS: A pre-tested self - administered questionnaire survey of a random sample of undergraduates of two University Campuses in Enugu, Nigeria. RESULTS: All the 505 respondents had heard of HIV/AIDS. The respondents exhibited a high knowledge of HIV/AIDS. For the 348 (68.9% ) respondents who had ever had sexual intercourse, the mean number of sexual partners, which they had before and after they became aware of HIV/AIDS did not differ significantly 93.2+ 1.7 versus 2.9+1.5; p = 0.3). However, there was a significant tendency towards a more consistent condom use after the respondents became aware of HIV/AIDS. On univariate logistic regression, being married (OR=2.8, <0.001), previous risky sexual behaviour (OR= 2.5, <0.0001) and being more than 20 years old (OR=1.4, p < 0.02) (but not respondents' level of knowledge of HIV/AIDS etc) were significant predictors of risky sexual behaviour after the respondents became aware of HIV/AIDS. On multivariate logistic regression - previous risky sexual behaviour (OR =2.5, <0.00001) and being married (OR = 2.1, p< 0.001) remained significant. CONCLUSION: High knowledge of HIV/AIDS has no correlation with subsequent sexual behaviour among Nigerian undergraduates.

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OBJECTIVES: To determine the pattern of aerobic bacteria isolated in patients with chronic maxillary sinusitis at the Ear, Nose and Throat Clinic of the University of Nigeria Teaching Hospital, Enugu, and the antibiotics sensitivity pattern of these organisms. METHODS: A prospective hospital-based clinical study. RESULTS: Fifty - four patients with clinical diagnosis of chronic maxillary sinusitis were evaluated. Out of 54 maxillary sinus aspirate specimens studied, 31 yielded bacterial growths and 32 no bacterial growth. The common aerobic bacteria isolated were Staphylococcus aureus (32.3% ), Pseudomonas aeruginosa and Escherichia coli were 16.1% each. Staphylococcus aureus was sensitive to Erythromycin, and the gram-negative organisms to Gentamicin. CONCLUSION: Bacteria isolated in chronic maxillary sinusitis and their sensitivity patterns varied. Bacteriologic study of the antral washings / aspirates should be done in every patient with chronic maxillary sinusitis. Combination chemotherapy that included Erythromycin and Gentamicin was recommended.

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This paper reports the concurrence of imperforate anus, oesophageal atresia and tracheo-esophageal fistula in a 24 hours old baby. The importance of the non-random coexistence of these anomalies is emphasised.

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OBJECTIVE: To determine if Nigerian women's knowledge of the risks of grandmultiparity has any correlation with their reproductive aspirations. METHOD: A structured interviewer-administered questionnaire survey of booked antenatal mothers seen over a 13-month period at the University of Nigeria Teaching Hospital, Enugu, Nigeria. RESULTS: One thousand, four hundred and thirteen (1413) women were interviewed from 1st July 2000 to 30th July 2001. Eighty-one (5.7% ) of the respondents felt that bearing 'too many' children was harmless while the remaining 1332 (94.5% ) felt it was harmful to their health. For these 1332 respondents, their definition of 'too many' ranged from 3 to 12 with a mean of 6.3 +/- 1.7. Over 60% of the 1332 respondents knew the common complications associated with grandmultiparity. Their mean desired family size was 5.0 +/- 1.4 (range: 3-10). At the beginning of their reproductive career, 38.9% of the respondents desired to be multiparous while the remaining 61.1% desired to be grandmultiparous. There was a significant positive correlation between the respondents' definitions of grandmultiparity and their desired family sizes (r = 0.5, p = 0.000). The respondents were categorized into: (a) those likely to become grandmultiparous,based on a desired family size = 5 and (b) those unlikely to, based on a desired family size < 5. Twelve of 33 variables tested as predictors of grandmultiparity were statistically significant on univariate logistic regression (p = 0.05). Apart from the respondents' definition of grandmultiparity, most of the other significant variables were socio-cultural factors; e.g., lack of post-secondary education (OR = 2.0); need to compensate for the small size of husband's family (OR = 2.3) and need for children who will take care of the respondents in old age (OR = 1.8). Knowledge of the specific obstetric risks associated with grandmultiparity was one of the 21 variables that were not statistically significant. On multivariate logistic regression, the respondents' definition of grandmultiparity was the only significant predictor of grandmultiparity (B = 0.6, OR = 1.8, p = 0.003). CONCLUSION: The higher the number of pregnancies a Nigerian woman perceives as being harmful, the more likely is she to become grandmultiparous. However,. there is no significant correlation between her knowledge of specific obstetric risks associated with grandmultiparity and her likelihood of becoming grandmultiparous. The implications of the results are discussed.

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