The aim of this study is to determine the prevalence and clinical features of intermittent testicular torsion in Enugu, Nigeria. All the patients seen in two health institutions in Enugu over a six-year period, with intermittent testicular torsion, were the subjects of this study. After history taking and physical examination, the patient's scrotum was explored and all the operative findings both in the ipsilateral and contralateral testes were noted. Testicular biopsy was taken from the affected side and all the patients had bilateral orchidopexy and were billed for follow-up for six months. A total of 69 patients with testicular torsion were treated during the study period. Out of these, 42 patients had intermittent testicular torsion, giving a prevalence of 60.9%. Their ages ranged from 10-43 years, with a mean of 23.8 years. All patients complained of intermittent pains in the scrotum. The duration of symptoms before presentation ranged from 6 months to 8 years. Majority of patients (66.7%) presented after having at least 20 attacks. Pain was felt unilaterally in 34 cases and bilaterally in 8 cases, but was commonest on the left (23 cases). On palpation of the scrotum, only 56.0% of the 50 affected testes were found to be mildly tender while the rest had no tenderness. Horizontal lie was found in only 38.0% of testes while the rest had normal lie. Epididymis was anterior to the testis in only 8.0% of the affected testes. At surgery, all the affected testes were found to have one form of abnormality or the other, clapperbell deformity being the commonest (76.0%). In the contralateral testes, clapperbell deformity was still the commonest finding (61.8%) while 17.6% were found to have no abnormality. The size of the testis was normal in 68.0% of the affected testes while the rest were either small or atrophic. Histology of the affected testis was normal in 38.0% while the rest showed either peritubular fibrosis (46.0%) or frank testicular atrophy (16.0%). Follow-up for six months in 35 patients showed no recurrence of symptoms and no reduction in testicular size. Diagnosis of intermittent testicular torsion should be urgently considered in young men with recurrent scrotal pains. Prompt management of this will avoid the possible ugly sequalae of vanishing testis, infertility and sterility.

Four hundred and twenty two female patients presenting with infertility at the University of Nigeria Teaching Hospital, Enugu, and Harriett Patterson Medical Clinic Enugu, were studied. All the patients had hysterosalipingogram done. This was followed by ultragonography and later by laparoscopy. One hundred and seven patients were found to have normal uterus and tubes, with peritoned spilage. This was confirmed at laparosocopy in 100 patients, ie 93.04 agreement. The findings of loculated spill at hysterosalpingogram could not be confirmed at lapatoscopy. Bilateral tubal block was found at hysterosalpingogram in 51 cases and confirmed at laparoscopy in 40 cases ie 80 persent agreement. Asherman's syndrome for obvious reason was not found at laparoscopy. Uterine fibroids and ovarian cysts were mostly discovered at laparoscopy and ultrasonography. Forty patients were found to have endometriosos, and severe pelvic adhesion were found in 35 patients at laparoscopy. Asherman's syndrome was discovered by hysterosalpingogram in 30 patients. The study shows that these three methods of investigation are complimentary to one another.

In this comparative study on sexuality, a validated questionnaire was administered to 440 medical students and interns from three tertiary institutions, Nnamdi Azikiwe University Teaching Hospital (NAUTH), University of Nigeria Teaching Hospital (UNTH), University of Benin Teaching Hospital (UBTH) and 152 non-medical persons domiciled around these institutions. This was to evaluate the knowledge of the two groups on sexuality and to make recommendations if any. The condom was the most popular means of contraception among 70. 37% of the medical and 29.63% non-medical persons. One hundred percent of the medical and 45.4% non-medical persons knew that the condom is not the most reliable method of contraception. Whereas 41.8% of medical and 37.5% of non-medical persons responded “true” to the statement “that the immediate result of castration is impotence”, 58.2% medical and 68.4% non-medical responded “false”. While 80% medical and 67% non-medical persons believe that three are two kinds of orgasmic response, 60% medical and 78.2% nonmedical believe that the immediate result of castration is impotence. About 58.8% medical and 35.1% non-medical believe that certain conditions of mental and emotional instability are demonstrably caused by masturbation. Although there are more correct answers by the medical group, there are no marked significant differences between the two groups as would be expected in a group that has gone through a curriculum on sexuality and one that has not. Presently, we are unaware of any programmed course on sexuality in any of our institutions. It is suggested that our medical students and interns go through a sexuality curriculum that will equip them to manage the increasing sexual health problems.

With the current upspring in the incidence of tuberculosis world wide, a corresponding rise in genitourinary tuberculosis should be anticipated. It is therefore imperative for the Urologist and general surgeons with interest in urology to be well abreast of the clinical course of this deadly condition. It should be stressed that all cases of haematuria should have their early morning urinary sediment stained for acid fast bacilli (AFB).

A pilot study to determine the impact of training community health workers in the identification and treatment of malaria in rural communities was undertaken. A rain forest area of south Eastern Nigeria was chosen for the study. The areas represent typical rural communities with hardly accessible roads, little physical infrastructure and nonavailability of health facilities. The study lasted for barely 4 months, between September to December 1997. Five community personnel with basic secondary schools level certificate were recruited and trained. The pre and post average scores were 37.7% and 73.3% respectively. The difference is statistically significant (teal = 9.43: t8, 0.05=2.31: P=<0.05). At the end of the study, a total of 788 patients were seen out of which 543 with malaria symptoms were diagnosed - after blood screening for malaria parasites. Forty Seven of those with malaria symptoms were identified to be severe and referred to the nearest health facility. While 421 cases out of the 788 films were correctly prepared. There was however a significant difference (p< 0.05) in the preparation of films from community to community showing variation in the level of understanding of the community Health Extension workers (CHEWS) posted to those communities.

Three patients underwent mitral valve re-replacement through a right thoracotomy using bicaval to femoral artery, deep hypothermia without aortic cross clamping or cardioplegia. The single indication was previous heart surgery through a median sternotomy. All the patients had straightforward non-complicated surgery and recovery with minimal blood requirements (2,3 and 3 units of blood respectively). Measures to prevent air embolism (which is the most important complication of this procedure) are highlighted. This is safer approach for open reoperations on the mitral valve. The exposure of the mitral valve is excellent, blood loss is less, operating time is shorter, and there is no problem in wound healing unlike resternotomy.

Plasma ascorbic acid (AA) levels were assessed in 66 children with malaria (36 with severe malaria and 30, non-severe malaria; 36 males and 30 females) seen consecutively at the Children's Emergency Room (CHER) of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, between May and August, 1997. This was done to evaluate the effect (if any) of malaria on AA, an acknowledged antioxidant, vis a vis the increased production of oxygen free radicals mediated by release of Tumour Necrosis Factor (TNF) as noted in malaria. Thirty healthy children of comparable ages and drawn from same geo-economic locale served as controls. Mean (SEM) Plasma AA level of 2.70 ± 0.10 mg/dl varied significantly from values obtained in controls (4.07 ± 0.16 mg/dl) (P < 0.01). The reduction in mean plasma AA levels was however more marked in-patients with severe malaria (2.31 ± 0.08 mg/dl) and in deceased (2.50 ±0.19 mg/dl). Mean plasma AA was not significantly influenced by age or sex. The reduction in Plasma AA may just represent an aspect of the complex pathophysiology of malaria. Clinical trials would be needed to determine if AA supplementation is warranted in childhood malaria.

The specialty of oral and maxillofacial surgery is not well known in many countries. In order to assess the knowledge of the public, the dental and the medical practitioners in Nigeria about this specialty, a questionnaire was devised. It comprised of nineteen specific questions and four different specialties , viz.: oral and maxillofacial surgery, plastic surgery, ear, nose and throat surgery and periodontology. These specialisations were used for choices of treating surgeons. The study, which was conducted by simple random sampling among the general public, medical students, dental students, dental and medical practitioners showed very interesting findings. The knowledge of the duties of the oral and maxillofacial surgeon varied from very poor (10%) among the general public to good (76%) among medical students and medical practitioners. Dental students and dental practitioners showed very good (90%) knowledge. It is therefore necessary that more concerted efforts be made to inform the general public and the health care providers of oral and maxillofacial surgery so that this specialty can be better utilised.

Four hundred and seventy-one consecutive antenatal mothers were interviewed to obtain their assessment of the antenatal care services rendered at the University of Nigeria Teaching Hospital, Enugu. Their overall rating of the services was: very good (36.3%); good (61.1%); bad (0%) very bad (0%); and mixed (2.5%). Their overall rating of the attitude of antenatal clinic personnel was good. Up to 61.1% of the respondents considered the services in the teaching hospital to be better than obtained in other hospitals in Enugu while the rest held a contrary view. Favourable aspects of the care included the health talk which 92.4% of the women attended and which 84.7% of them found useful. Aspects of care disliked by the mothers included the long waiting time, the costly nature of the services, examination in the presence of medical students and the prescription of individual haematinics instead of the more costly but single dose alternatives. It was concluded that frequent auditing of antenatal services is necessary to highlight areas requiring improvement.

Epilepsy is a chronic neurological disorder sometimes associated with various forms of psychiatric disturbances. Depression, one of such disorders is commonly reported as being higher in epilepsy than in the general population. In a study to determine the prevalence of depressive symptoms in adolescents and young adults attending the pediatric neurology clinic of the University of Nigeria Teaching Hospital, Enugu and also identify clinical factors associated with these symptoms, 60 epileptic patients aged 16-23 years were screened for depressive symptoms using the Zung self-rating Depression scale (SDS). Their results were compared with those from 54 controls. Thirty-one patients (18 males and 13 females) or 51.6% had depressive symptoms (i.e SDS indices of 50 and above) as compared with 12 controls (22.2%). This was statistically significant (Z=2.84 P<0.005). Sixty seven percent (67%) of patients aged 20-23 years had depressive symptoms as compared with only 49% of patients aged 16-19years. This was statistically significant with P value < 0.001. Sex and social class did not affect the SDA scores. Depressive symptoms were commonest in patients with generalized tonic-clonic seizures and complex partial seizures. Also there was significant relationship between seizures control and SDS score (X² = 9.91 P < 0.001). It is concluded that depression is a significant problem in adolescents and young adults with epilepsy, and prevalence is influenced by seizure-type and the level of seizure control.

Ten patients complaining of Dyfunctional Uterine bleeding were given Duphaston tablets from day 16 to 25 of the menstrual cycle. In eight of the patients, the menstural cycle became regular after 3-6 cycle of treatment. The other two patients were re-evaluated with ultrasound, and found to have endometrial polyps. There were no adverse side effects. Duphaston tablets can be used to correct dyfunctional uterine bleeding.

Battering is well known in medical circles as regards wives and children. To be recognized also is the battering of surgical specimens. This is as a result of autolysis that supervenes on account of inadequate formalin fixation. In a period of 30 years, 170 such cases were submitted to the author in Enugu by 98 doctors working in 25 hospitals in Enugu and in 37 hospital elsewhere. Up to 71 doctors submitted single specimens. For the rest, the respective totals varied, but one gynecologist sent in the maximum of 13 rotten specimens. Although fake formalin may be part of the answer, the clinician will do well to provide both sufficient summary and specious specimens in keeping with the status of the pathologist as a team mate rather than a wizard.