The present study was carried out to determine the effect of testosterone therapy on Erectile dysfunction (ED) patients with normal and low testosterone levels. One hundred men attending the urology clinic for erectile dysfunction, in whom no obvious organic cause of ED was found, and in whom cancer of the prostate had been ruled out, were the subjects of this study. After a full history and clinical examination, male hormonal profile was done with particular emphasis on serum testosterone level. The patients were grouped into two, Group A comprised those with normal serum testosterone levels (3-10 ng/ml) and Group B those with low serum testosterone (<3 ng/ml). All the patients had three injections of 250 mg sustanon at 3 weekly intervals. Twelve weeks after the commencement of testosterone therapy, a repeat serum hormonal profile was done and the patient re-assessed for libido and potency. Out of the 100 men studied, 30 were above 50 years of age while the rest were below. There were 78 men in group A and 22 in group B. All patients had normal LH, FSH and prolactin levels. Twelve weeks after the onset of sustanon therapy, all the patients showed normal serum testosterone levels, with those in group B maintaining normal LH, FSH and prolactin levels. However, in group A,. 82.1% had marked reduction of LH and FSH levels though showing no obvious change in prolactin levels. In group B, libido was improved from initial 63.6% to 86.4% while potency was improved in 54.5%. In group A, libido was improved from the initial 79.5% to 82.1% while potency was improved in 11.5%. In the present study group, testosterone therapy improved both libido and potency in a good number Of ED patients with low serum testosterone levels. It was not particularly useful in ED patients with normal testosterone levels. Routine administration of testosterone to all ED patients should be discouraged. If it has to be administered, prior testosterone assay should be carried out.

The predictive value of symphysio-funtfai height(SFH) measurements in fetal macrosomia was evaluated in a prospective cross-sectional study of 378 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, Eastern Nigeria over a three and half months period. Different cutoff levels of SFH were tested for ability to predict macrosomia (defined as a birthweight ≥4000g) by calculating the sensitivity, specificity, false-positive rate etc. The discriminatory power of SFH in predicting fetal macrosomia was determined by constructing a relative operating characteristic(ROC) curve and, testing, the area under the curve for significant difference from the area under the ROC curve for y = x. A cut-off level of SFH ≥ 40cm maximised both the sensitivity and specificity of SFH in predicting macrosomia (X² 168.6, p = 0.0000). The area under the ROC curve for SFH was significantly different from the area under the ROC curve for y = x (p = 0.001). It was concluded that SFH ≥40cm is a good cut-off for predicting fetal macrosomia and is a useful alternative to ultrasonography in our population.

A retrospective study of the surgical biopsy spectrum of a Nigerian ophthalmic practice over a 14 year period (January 1986 - December 1999) was undertaken. This is to highlight the commonly encountered diseases and stress the need for histopathological investigation in ophthalmic practice. A total of 89 specimens (from 85 patients) were received during the study period. The commonest anatomical sites of the specimens were whole globe (39.3%) conjunctiva (29.2%), orbit (15.8%) and eyelid (6.8%). Retinoblastoma was the histopathological diagnosis for most of the whole globe and orbital specimens. The rest of the whole globe specimens were mainly staphyloma (22.9%) and inflammation (including panophthalmitis and endophthalmitis)(31.4%). The diagnoses of the lid lesions agreed both clinically and histopathologically except for one patient who was clinically diagnosed as a case of squamous cell carcinoma but histologically turned out to be granulormatous inflammation. It is advocated that all ophthalmic surgical specimens should be subjected to histology as some malignant lesions could masquerade clinically as benign lesions.

Histopathoiogical findings in 170 Ibo women with postmenopausal bleeding were reviewed retrospectively over a 29 yesr period. In descending order, they were atrophic endometrium 21.7%,senile cystic endometrium 11.1%, squamous cell carcinoma of the cervix 11.1%, proliferative endometrium 10% adenocarcinoma of endometrium 9.4%,endocervical polyps 8.2%; endometrial hyperplasia 5.2%, uterine sarcoma 5.2%, secretory endometrium, endometritis, endometrial polyps, pyometria 2.9% each; chronic cervicitis 2.3%, squamous metaplasia 1.1% and others. It is concluded that such women should have both endometrial curettage and cervical smear. Furthermore, a coherent policy of genital cancer screening must be urgently formulated.

Objective: To identify the risk factors for intrauterine growth restriction in Nigerians. Methods: A prospective study of eighteen putative risk factors in 1149 consecutive singleton normal live births at the University of Nigeria Teaching Hospital, Enugu Eastern Nigeria, over a 13 month period. Results: On univariate analysis, the following variables were statistically significant risk factors for IUGR - primigravidity, unsatisfactory feeding during pregnancy, lack of antenatal care, low socioeconomic status (as shown by husband's monthly income <$100, absence of a family car, low educational status, residential accomodation ≤ 2 rooms) and anaemia in pregnancy in order of importance. On multivariate analysis, the following were statistically significant factors unsatisfactory feeding during pregnancy, lack of antenatal care and primigravidity in order of importance. Conclusion: The prevalence of IUGR in Nigerians can be reduced by attention to these risk factors.

Impairment of gas-exchange during general anaesthesia with artificial ventilation and in the immediate post-operative period is a well-known finding. We have assessed the effect of different factors on the incidence and duration of post-operative hypoxaemia in 100 randomly selected surgical patients. In a prospective study over a one-year period using a Nellcor N180 oximeter, pre- and post-operative oxygen saturation while patients were breathing air were measured. Significant differences between pre-operative and post-operative oxygen saturation (SP02) were found in 27% of patients in our series. Patients at increased risk of persistent hypoxaemia were obese patients. (BM1 25-35kgm²) post thoractomy and upper abdominal surgery, patients on respiratory depressant drugs, patients with acute airway disease e.g. pulmunary oedema, pulmonary embolism, oral and throat surgery. Other groups of patients to be closely observed are anaemic patients (Hb 7gm/ dl) febrile patients and hypovolemic patients (Low CVP. Oligiria). There was significant association between low SP0² and recovery scores. Oxygen therapy and monitoring with pulse oximeter are therefore highly recommended in the immediate post-operative period till SPO₂ breathing air is above 94% or has returned to pre-operative values.

Thyroid disease is common in Nigeria with several localities of endemic goitre. Clinical diagnosis is the main stay of diagnosis in rural areas because of lack of facilities for biochemical thyroid function test and histological examination of specimens. Moreover, with the depressed national economy, many of these patients cannot travel to the centres where these expensive investigations are done. A review of case notes of 140 patients and prospective study of 102 patients with thyroid disease were carried out. Out of 25 clinically diagnosed cases of hyperthyroidism 23 were biochemically confirmed. Also, of the 18 patients with clinical picture of thyroid carcinoma, 15 had histological confirmation. The study shows that hyperthyroidism and thyroid carcinoma can be diagnosed clinically with over 80% accuracy in the hands of experienced senior doctors. Therefore, only doubtful cases need detailed high powered investigations in such situations.

An emerging picture through comparative studies at the University of Nigeria Teaching Hospital Enugu (1976-1981) and (1986 -1992) shows that the incidence of cholecystitis and cholelithiasis is on the increase in our society and the number of cholecystectomies performed in our hospital has risen in recent years.

A 15 year retrospective study of 55 pregnant patients who underwent laparotomy between January, 1984 and December 1998 revealed an incidence of 0.07 percent (1 in 1535 deliveries). Ovarian cystectomy was the commonest (38.2%) abdominal surgery performed during pregnancy, followed by intestinal obstruction (23.6%), appendicectomy (18.2%), ophorectomy (10.9%), myomectomy (5.5%) and cholecystectomy (3.6%). Sixteen (29.1%) patients had surgery in the first trimester, thirty (54.5%) second trimester and nine (16.4%) in third trimester. The outcome of pregnancy was dependent on the type of surgery, timing of the operation and degree of surgical delay. Premature labour, abortion and wound infection are common complications. Two (3.6%) maternal death were recorded following perforated appendix. There were 19(34.5%) fetal losses among the patients. Early diagnosis and timely surgical intervention will result in better perinatal and maternal outcome.

An appraisal of the knowledge, attitude and practice of doctors and midwives towards women infected with human immunodeficiency virus (HIV) was carried out. The data were collected using a cross-sectional self report questionnaire. Heterosexual transmission was known (92.2%) to be the commonest mode of transmission. Among the respondents, 49.4% knew that vertical transmission could be reduced through drugs. Majority (92.3%) wanted the cost of screening, confirmatory test and treatment reduced. However 83.5% support mandatory screening. Only 53.8% of the respondents would accept to nurse and treat HIV positive mother. It was found that 42.8% do not carry out pretest and post test counselling and 61.5% admitted that they do not inform their patients about their HIV status when the test is positive. All the respondents admitted that they do not use antiretroviral drugs in the management of HIV positive pregnant patients. In conclusion, pregnant women infected with HIV virus do not receive optimal medical care for their condition. It is wrong to believe that they are well accepted by the attending doctors and midwives. To improve on these, effort should be made to train and retrain doctors and midwives in the prevention, diagnosis and management of this disease. Additionally antiretroviral drugs should be made available and affordable.

An indwelling intermittent drainage method of thoracocentesis in acute free flowing empyema thoracis is devised and used in treating the three cases reported here. In it, a size 16 bore cannula with fenestrations on the sides is inserted, into the intrapleural space of an affected side, at the 8th intercostal space (or the 6th intercostal space on the right) posterior or mid axillary line. Thereafter, the intrapleural space is drained, intermittently, using disposable gloves and syringes. These cases, all being children aged 2 weeks, 1 year and 1½ years responded very well to the treatment.

In a survey of the incidence, severity, and significance of medical student abuse as perceived by the student population of a major medical school in Nigeria, 171 (74%) out of a total 231 respondents stated that they had been abused at some time while enrolled in medical school. The abuses ranged from verbal, physical, psychological to sexual. Fifty-three (22.9%) of the students reported having become more cynical about academic life and the medical profession as a result of these episodes. Sixty (26%) felt that they were worse off than their peers in other professions. Forty-four (19%) reported that they would have chosen a different profession had they known in advance about the extent of mistreatment they would experience. Summarising the positive and negative effects that medical school had on their lives, 180 (77.9%) cited the ability to withstand stress as a positive by product among others, and 231 (90.9%) saw the fact that they had no time for social life as negative. We conclude that medical student abuse should not be dismissed as an isolated event; rather it should be a major concern of those involved with medical education.

Vernal keratoconjunctivitis(VKC), a common ocular disease, is one of the allergic eye diseases. It has a worldwide distribution but is more common in hot countries. Fifty per cent of sufferers are aged between 6 and 20 years. More males are affected than females before puberty and 90% of cases resolve within 10 years of the disease onset. VKC is classified into 3 types: the palpebral or tarsal form, the limbal or bulbar form and the mixed forms. The corneal signs of the disease range from the benign punctate epithelial keratitis to the plaque formation. Sight-threatening complications could result from corneal involvement or indiscriminate use of steroids. Apart from steroids advised to be used only during exacerbations of the disease other safer treatment options include topical mast cell stabilisers and antihistamines.

This article provides a review of literature and UNTH experience of the aetiology, complications and management of sinusitis. The findings suggest that causes included inflammation, allergy, neoplasia, immune deficiency and dentogenic diseases. Males and females of all ages were afflicted. Presenting symptoms and investigative modalities are hereby listed. Treatment of sinusitis was both conservative and surgical especially where conservative management had failed. Functional endoscopic sinus surgery now the standard modality for surgical treatment of chronic sinusitis is discussed. This method which has changed the current concepts of sinus anatomy physiology and pathogenesis is preferred. Disease complications were mainly orbital and intracranial. Surgical complications are also reviewed. The need for acquiring modern instruments (operating microscopes, endoscopes, sinoscopes) for sinus surgery is hereby highlighted.

Readings from the Holy Bible are analyzed. They indicate that theological texts abound on the pains experienced by women during the birth of children.