Six cases of iatrogenic injuries to the extrahepatic bile ducts are presented. All resulted from open choleystectomy. At presentation, the patients' general conditions were generally poor with severe hypohydration. Four patients were re-explored after resuscitation and were successfully reconstructed while two patients died while being resuscitated. Early recognition and timely referal are advised. Adequate and effective resuscitative measures to control sepsis and prevent renal failure, close monitoring of the biochemical and haematological indices and the cardiovascular system, facilitate early and expeditious reoperation.

Femoral Venous Blood Velocity (FVBV) was measured using ultrasound velocimeter with a purposed-designed probe holder before and after insertion of graduated elastic leg compression stockings. There was a statistically significant increase in venous blood velocity following the application of leg compression (Mean frequency of spectrum, 247 Hz) compared to that before its application (Mean frequency, 201 Hz) (p<0.05). This significant increase in venous blood velocity may reflect a critical mode of action of external leg compression in the prevention of deep vein thrombosis (DVT).

A case of the rare complication, Purtscher's retinopathy, following trauma in a 34 year-old Nigerian Igbo man is reported. The young man who was the backseat passenger in a bus, in which following a road traffic accident one of the passengers died, noticed diminution in vision of the left eye after a brief period of loss of consciousness. Associated with this unilateral visual loss were right lower lid loss, right mandibular and femoral fractures.

A three year prospective study to establish the incidence, causative organisms and their antibiotic sensitivity pattern, and predisposing factors, of bactcraemia occuring following open prostatic surgery, was undertaken in our urological unit between July 1994 and June 1997. A total of one hundred consective patients undergoing open prostatectomy were studied. Note was taken of the presence or absence of indwelling urethral catheter pre-operatively and cultures of the external urethral meatus, antecubital fossa and removed prostate were done. Blood was drawn immediately before surgery and two hours post-operatively for culture and the patient observed for features of septicaemia. The incidence of post-operative bacteraemia was 33%. E. Coli (60.1%), proteus spp (33.3%), staph aureus (3.0%) and strep faecalis (3.0%) were the offending organisms. The patterns of antibiotic sensitivity of these organisms were in favour of gentamicin, ofloxacin (tarivid), ciprofloxacin (ciproxin) and co-trimoxazole, especially for both E.Coli and proteus spp. Significant correlation was found between bacteraemia on one hand, and positive prostatic bacterial culture, pre-operative bacteriuria and pre-operative indwelling urethral catheter, on the other. None of the bacteraemias led to septicaemia. Peri-operative prophylactic antibiotic therapy is recommended especially in these high risk patients so as to prevent the potentially fatal complication of septicaemia.

Gunshot injuries (GSI) among Nigerian civilian population are on the increase. This is attributed to the rising violent crime rate, interconimunal conflicts as well as indiscriminate social use of firearms. GSI to the head and neck is often fatal. Only the lucky few survive it to hospital. This paper is a reivew of GSI to the head and neck that presented to the authors at the University of Nigeria Teaching Hospital (UNTH) Enugu, and Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi over a 5-year and 2-year periods, respectively, both ending March 1998. There were 5 males and 3 females, age range 15 - 45 years. Armed robbery attack was the most common (4/8) motive. Suicide attempt and accidental discharge of gun were noted in one patient each. Morbidity included: binocular blindness(2), uniocular blindness (1), significant facial deformity (2) and change in affect (2). Problem of management of GSI are discussed.

The effect of potash extract from plant source in the management of blood pressure was carried out using albino rats. Urethane (an anaesthetic) was used for the rats at a dose level of 5.25 ml/kg body weight in normal saline solution. An anticoagulant (heparinized normal saline solution 10iu/ml) was also employed. The general vasoconstrictor used was nor adrenaline. It was shown that potash extract had a significant reductive effect on the arterial blood pressure to about 72% in the albino rats. This may have some health implications as it could be used in the management of hypertension.

The retrospective review of 30 consecutive cases of heart failure in pregnancy at the University of Nigeria Teaching Hospital Enugu, over a ten year period 1987 - 1996 was done. The study determined its aetiological pattern, maternal and fetal outcome. Data were based on ward, labour ward records and case note reviews. Cardiac decompensation was confirmed to have occurred in 1:544 live births. Twenty four (80.0%) of the patients were unbooked and most were illiterate housewives. Heart failure occurred due to systemic disease in 56.7% of patients with 36.7% being due to severe anaemia. The heart lesions seen in the rest of the patients were dilated cardiomyopathy (13.3%), hypertensive heart disease (10.0%), mitral stenosis (10.0%) and ventricular septal defect (3.3%). Maternal mortality occurred in 23.3 % of cases and there was a 50.0% perinatal mortality. Unlike perinatal mortality, 71.4% of the maternal deaths were of preventable aetiology.

Fifty-six cases of sexual abuse on Nigerian female children have been analysed. Cases of sexual abuse represent 0.8% of all cases referred to the consultant gynaecological/Paediatric out-patient clinics. Cases of sexual abuse on Nigerian children may be much more than we have reported since most parents and guardians do not like to report such cases to doctors or the law enforcement agents. Various forms of sexual abuses have been defined.

Through a questionnaire survey, the views of 260 Nigerian Igbo parturients, 170 of their husbands and 172 medical personnel were sought to determine the desirability or otherwise of allowing parturients' relatives by their bedside during labour at the University of Nigeria Teaching Hospital, Enugu. Previously, this was not the practice in our hospital. Seventy five percent of the parturients, 88% of the husbands and 82% of the medical personnel favoured the presence of a parturient's relative. Forty-six percent of the parturients who would want a relative during labour preferred their husbands while 54% preferred another female relative. Sixty four percent of the husbands favoured being physically present during labour while 28% preferred the presence of other relatives. Ninety-two percent of the medical personnel preferred the husbands to other relatives. The major reasons proffered by the respondents were increased psychological and physical support for the parturients. It is concluded that allowing parturients' relatives by their bedside during labour should be encouraged.

In a study of the disease pattern of the elderly in Nigeria, a sample consisting of 352 patients aged 60 years' and above hospitalised between January 1995 and December 1996 at the Medical Wards of a major Teaching Hospital were reviewed retrospectively. The problems most frequently encountered were the cardiovascular diseases (especially hypertensive heart disease and cerebrovascular accident) which accounted for 186 (52.8%) of all the admissions. Neoplasms, especially hepatoma and cancer of the prostate were next in frequency, occurring in 42 (11.9%) of the admissions, followed by endocrine, nutritional and metabolic diseases (56 or 10.2%), respiratory disease (30 or 8.5%), disease of the nervous system (24 or 6.8%), disease of the digestive system (18 or 5.1%) and renal diseases 16 or 4.5%). The median stay in hospital for the patients was 18 days.

End Stage Renal Disease (ESRD) is common world wide including Nigeria. The 3 modalities of treatment are kidnej transplantation, maintenance haemodialysis and continuous ambulatory peritoneal dialysis (CAPD), all of which are expensive. The study analyses the cost of these 3 modalities of treatment at three and five years respectively. The findings indicate maintenance haemodialysis as the most expensive modality of treatment while CAPD is the least expensive, at three and five years. Kidney transplantation is a cost-efective mode of treatment in the long term. It is recommended that where resources are available and in the absence of contraindications, kidney transplantation should be the priority. Efforts should be made to anticipate and prevent peritonitis in CAPD. The cost of treatment of ESRD in Nigeria is exorbitant and beyond the reach of the average person. There is need for some form of subsidy by the State or insurance.

A National Health Insurance Scheme (NHIS) was launched in Nigeria in 1997 with the major aim of mobilizing additional sources of funds as well as expanding and improving access to health care. Health professionals such as doctors, nurses, pharmacists and medical laboratory scientists can play a crucial role in the successful implementation of the NHIS through their influence on the nature, quantity, quality and cost of health care. This study was therefore conducted to assess the level of awareness, perception and attitudes of Nigerian health care professionals towards the NHIS. Six hundred and ninety seven health professionals practicing within the south-east geo-political zone of the country were recruited into the study. Majority of the respondents were practising in either university teaching/specialist hospitals (35.1%) or private clinics/hospitals (20.5%). Approximately 73% of the respondents had heard of the NHIS. Their main source of information on the NHIS were newspapers (39.8%) and Radio/TV (37.2%). Only 12.2% of the respondents knew who the scheme will cover. Sixteen percent of the respondents knew that providers will be paid either by capitation or fee-for service mechanism. In terms of the attitudes of the health professionals to the NHIS, 88.1% believed that the scheme will improve health care in Nigeria while 91.4% were willing to participate in the scheme. Only 8.9% were satisfied with the level of information available to health care providers. Sixty eight percent of the respondents believed that the scheme should cover the entire population compared to only 12.2% who believed that the scheme should be restricted to those on the formal wage sector. Eighty-four1 percent of the health professionals want the scheme to cover all aspects of health care ranging from primary to tertiary care. The implications of the misconceptions and inadequate knowledge on the NHIS among health care professionals is discussed.

Campylobacter jejuni was isolated from the stools of 47 out of 636 children (7.4%) aged 5 years, with acute diarrhoea. Significantly more children from the rural than from the urban environment had C. jejuni enteritis (26/224 Vs 21/407, P 0.01). There were no differences with respect to sex. The age group at greatest risk were the 7-12 months old. Campylobacter jejuni is an important aetiological agent of bacterial diarrhoea in children and should be routinely looked for while investigating childhood diarrhoea especially if the child is under two years of age.

The lucid interval experienced by some patients before death has been described consistently for ages. This study reviews the phenomenon from historical, statistical, cross-cultural, and apocryphal perspectives. Lucidity before death is an intriguing facet of the dying process. It merits wider recognition and prospective research.