Nigeria witnessed rapid expansion in the number and student enrolment of medical schools between the mid 70s and the 90s. Between the mid 80s and the 90s, several senior and experienced academic medical staff emigrated to Middle East, Europe and America because of the adverse socio-economic and political situation in the country. This, coupled with the deterioration in the infrasrtucture stretched the capacities of the medical schools to cope with the challenges of producing competent medical doctors for the society. This situation has underscored the need for changes and reforms in the medical education system in Nigeria. Medical education reforms in Nigeria will be in conformity with the views of World Federation for Medical Education, which has, since the Edimburgh Declaration of 1988, encouraged medical schools to introduce reforms that will enable them meet with the challenges of producing competent physicians for the 21st century. The aspects of medical education that need reforms have been suggested. They include the curriculum, learning strategies, staff development, student selection, assessment and evaluation. It is emphasised that through all these reform processes, medical education should be seen as a continuum, a life-long process of learning to maintain life-long competency in medical practice.

There have been conflicting reports regarding the biochemical status of thyroid function in normal pregnancy. The objective of the current study, therefore, was to detect biochemical thyroid dysfunction among healthy pregnant women in Enugu and, if found, to elucidate the pattern.One hundred and sixty three apparently healthy women with normal pregnancies who attended routine antenatal clinic in a general maternity hospital in Enugu, Nigeria from September 6 to October 18, 1994 were consecutively recruited into the study. Each of the subjects exhibited an aberrant value in one or more of the biochemical indices studied. In terms of the biochemical status of their thyroid function, 95 (58.3%) of all the pregnant women had both TSH and FT4 values within the laboratory reference ranges and so had features compatible with euthyroidism. The remaining 68 (41.7%) had some aberration in either the TSH or the FT4, or in both. Forty one (25.2%) had biochemical features suggestive of stage 2 hypothyroidism (high TSH + normal FT4), 19 (11.7%) had features indicative of stage 3 hypothyroidism (high TSH + low FT4), 3 (1.8%) had TSH and FT4 values within hyperthyroid ranges while 8(4.9%) had indeterminante status of thyroid function. It is concluded that patterns of biochemical indices of thyroid function compatible with primary hypothyroidism appear to be quite common among apparently healthy pregnant women in Enugu. However, biochemical hypothyroidism in pregnancy is more likely due to gestation than due to thyroid disease if serum TSH concentration is less than 11mU/L.

Ambiguous genitalia represents a rare but important group of disorders. This genital anomaly commonly presents with an abnormal external genitalia with or without associated metabolic complications. There is a need for early diagnosis so that appropriate sex of rearing can be assigned early in life. Our 22 year old patient who was intially reared as a female is presented to underscore the diaster of inappropriate sex choice early in life. On presentation, he had an amenorrheic female phenotype with male secondary sex characteristics. There were bilateral undescended testes at the external inguinal rings, fused phallus and labioscrotal folds, with the urethral orifice between them. At surgery, there was defficient corpus spongiosum, with lots of cavernisal tissues folded below the pubic symphysis. Bilateral orchidopexy and one-stage genitoplasty were done and the patient now has a male-looking external genitalia. The awareness in our environment, psychological and social embarrassment, limitations to management and the role of surgery in sex assignment are highlighted.

In order to evaluate the mode of presentations and outcome of treatment of carcinoma of the stomach a retrospective study of cases managed during a ten year -period at the University of Benin Teaching Hospital was conducted. Records of all patients with carcinoma of the stomach were examined and all relevant informations were extracted. A total of 26 patients were reviewed for the study. There were 16 males and 10 females with a peak incidence in the 6th decade. All the patients presented with advanced carcinoma of the stomach and the majority had features of gastric outlet obstruction. Palliative resection was feasible in only 42 percent of cases, the remainder having either palliative gastrojejunostomy or biopsy only. Tubular adenocarcinoma was the commonest histologic type. Over half of the patients died within 18 months of diagnosis. We conclude that carcinoma of the stomach although not very common in our environment is assoiciated with high mortality as a result of late presentation.

The management of Retinoblastoma in Enugu, Nigeria is outlined and compared with current approach to management in developed world. Retinoblastoma is a very important life-threatening tumour in Nigeria and is not as rare as previously thought. Since it is a potentially curable disease, all involved in the management are urged to take steps towards preventing, first death from this tumour, and subsequently blindness.

The incidence of cholecystitis and cholelithiasis in Tropical regions are reportedly less than those in advanced countries. Attempt is being made here to find out the incidence at U.N.T.H Enugu (1975 - 1981) with a view to comparing it with other parts of the world.

Past studies on the influence sociodemographic factors have on the prevalence of psychoactive substance abuse and as aetiological determinants have yielded conflicting results both within and outside Nigeria. This study was undertaken to find out the pathoplastic influence of sociodemographic variables on substance abuse among secondary school students in an Ubran School in Enugu Nigeria. Most of the students (61.3%) were aged between 10 - 14 years. Parental drug use vis-a vis drug use among students were positively correlated (p ≤ 0.05). Many of the students (83.3%) also identified their parents as the ones who introduced them to drug taking. There was no statistically significant difference between coming from a polygamous home as against monogamous home in the prevalence of drug abuse (p ≥ 0.05). Some students (31.0%) indicated that they took drugs to shake off unhappiness while an equally large number took drugs to be able to keep awake at night, ostensibly to study. The authors stressed the need to identify further aetiological factors in drug abuse so that efforts can be geared towards primary prevention.

Four hundred and twenty patients who presented to the Otorhinolaryngology Clinic of the University of Nigeria Teaching Hospital, Enugu, in 1997 and 1998 with non-neopiastic causes of rhinorrhoea were retrospectively studied. Spectrum of diseases diagnosed are:- Chronic Sinusitis 166 (40%), Allergic rhinitis 142 (34%), Rhinosinusitis 107 (25%); forgotten foreign body in nasal cavity 3 (0.1%). Their ages ranged from 2-79 years, Male to female ratio was 1:1, We conclude that rhinorrhoea is a prevalent source of morbidity in our environment with majority having treatable causes.

A review of 12 cases of gunshot wounds treated at the Maxillofacial Unit of the University of Nigeria Teaching Hospital, Enugu between January 1990 and December 1997 showed that violence was responsible for 11 cases (91.7%), and only 1 case (8.3%) was due to the accidental discharge of a gun. Out of 12 patients seen, 10 were males and 2 were females, giving a male to female ratio of 5:1, with the age range from 5 to 50 years. Ten (83.3%) of the patients were injured by low velocity missile, and 2 (16.7%) by high velocity missile. Analysis of the injuries sustained showed that 10 (83.3%) patients had soft tissue injuries. Among them, 1 patient had a fracture of the upper right central incisor caused by a pellet and 2 patients sustained injuries to the branches of the facial nerve. Two others had both mandibular fractures and soft tissue injuries. All the patients had initial wound toilet and debridement after resuscitation. The fractures were treated operatively as a secondary procedure. There were satisfactory results in all cases. In view of our experience, we recommend that gunshot wounds should be managed initially by resuscitation of patient, followed by early wound exploriation, debridement and delayed primary closure and not as ordinary surgical wounds irrespective of the type of gun used. Definitive treatment of associated fractures or other associated injuries should be done as a secondary procedure.

Twenty one of 222 premenopausal women with breast cancer developed the disease in association with pregnancy. Eleven were pregnant while ten were post partum. There were significant delays before consulting surgeons for assessment and treatment Two of the patients came in the second trimester while the remaining nine came in the third trimester. Standard surgical therapy after some delay was employed for ten of these patients. One of them refused surgical treatment after biopsy. Most of the patients had chemotherapy and 3 had tamoxifen. There was favourable obstetrical outcome in ten patients while one had a low birth weight baby. The histological spectrum found in these patients was the same as in the non pregnant patients. The incidence of breast cancer related to pregnancy in this premenopausal group was 9.4%. Breast cancer related to pregnancy is an infrequent but serious problem requiring skilled and compassionate management It is not a different disease in any way from that in the non-pregnant and therefore should be treated without delay.

During the period covered by this study (October 1987 to December, 1993), 8612 clients were counseled and accepted a contraceptive method. Of this number, a total of 456 (5.3%) female sterilizations (Bilateral tubal ligation) were done. Minilaparotomy sterilization constituted 3.6% of the total and these 312 clients formed the basis of this study. In 87% of the clients, there was either primary or no formal education, while 47% of the clients had used another form of contraception before deciding for sterilization. Self referral was the commonest source of referral to the clinic. The main indication for minilaparotomy sterilization were completed family size (84.6%), economic conditions (11.9%) and health reasons (3.5%). Majority of the clients were grand muciparous women in their thirties. The mean age and parity at sterilization were 35 years and Para 8 respectively. In 85% of the clients, there was an interval procedure and local infiltration with or without sedation as the anaesthetic technique of choice. There was no anaesthetic complication in this study while complication attributable to the procedure occurred in only 1.6% of the clients with wound sepsis as the commonest The increasing demand for minilaparotomy bilateral tubal ligation which is simple, safe, effective and inexpensive calls for training of more personnel to meet this need.

Acknowledgements occupy a niche in scientific journals. What are their characteristics? For an answer, the 36 papers which constituted in large measure the author's Glasgow University M.D. Thesis were analysed. Up to 16 of them explicitly had an acknowledgement section which directly embodied thanks. Because some details recurred, there were named doctors (16 times), technical staff (9 times), medical artists (3 times) and regional librarian (once), while there were named foreign experts based in USA (thrice) and UK (twice). In the other 20 papers, there was general mention of both the receipt of surgical specimens from unrfamed doctors (11 times) and their being processed in a (free) central laboratory (8 times). The single remaining paper was a joint work of the author and two clinicians. It is concluded that, just as one should acknowledge the importance of a scientific journal based in a postgraduate institution, researchers should strive always to “Do justice to any help received”.