Objective: To define the incidence of, and factors contributing to the complications of colostomy and colostomy closure at the University College Hospital, Ibadan, Nigeria. Patients and Method: Retrospective review of hospital records of all the patients that had colostomy/colostomy closure in the hospital from 1985 to 1994 was conducted. Two hundred and sixty nine colostomies were performed, 154 of which were fully evaluated. Loop colostomies on the sigmoid (35.7%) and transverse colon (27.3%) were most commonly performed. Indications for colostomy in adults were rectal carcinoma, acquired fistulae, colorectal injury and colonic obstruction. Anorectal anomalies and Hirschsprung's disease were the indications in children. Complications and deaths related to colostomy and colostomy closures were noted. Results: Death rate was 17.6% mostly from sepsis. Mortalities were higher (p<0.05) in neonates, emergencies, anorectal anomalies, colonic obstruction, rectal prolapse and cases done by resident doctors. Overall, morbidity rate was 60.5%. The most common complication was colostomy prolapse, which occurred most frequently in loop colostomies. Significantly higher morbidity (p<0.05) was recorded in children, loop colostomies and cases done by resident doctors. Fifty-three of 117 temporary colostomies were closed without mortality. Complication rate was 54.7%, mostly from wound infection (45.3%). Faecal fistula was the most difficult complication of colostomy closure. Conclusions: Morbidity and mortality of colostomy is high in Nigeria. More consultants' inputs are needed in colostomy creation especially in neonates, emergencies, obstructed cases and patients with rectal prolapse. Primary closure of colostomy wounds should be avoided.

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Aim: To determine the relative effectiveness of treatment of urethral structure by intermittent bouginage and serial catheter dilatation. It also compared the cost implications, complications and patient's acceptance of the two methods. Patients and Methods: This is a prospective study involving a total of 87 patients attending the urology clinic at UNTH from the 1st of January 1995 to 31st December, 1999 inclusive. These patients were randomly grouped into two: group A includes those treated by intermittent bouginage while group B are those by serial catheter dilatation. The study involved meticulous documentation of the cost treatment, assessment of treatment results in terms of how satisfied the patients felt with the treatment-options. The complications and acceptance rates were also recorded. Results: There were 35 patients in Group A and 52 in Group B. Sixty five percent of the patients were aged between 30 and 60 years making up 75% of the total patients. The compliance rate at 5 years was 51% for group A and 94% for group B. It costs a total of four thousand five hundred and eighty five naira (N4,585.00) now for intermittent bouginage and two thousand one hundred and eighty naira only (N2,180.00) for serial catheter dilatations. The complications were higher with intermittent bouginage than with serial catheter dilatation except the psychological burden, which was more with serial catheter dilatations. Conclusions: It is unequivocally obvious that serial catheter dilatation is cheaper, has a better acceptance and associated with minimal complications compared to intermittent bouginage. Serial catheter dilatation is more cost-effective than intermittent bouginage. It is therefore recommended.

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Objective: To describe the derivation, accuracy, and limitations of a new formula for estimating birth-weight using symphysiofundal height measurement in centimetres. Methods: The derivation of the formula was described. The formula was then applied to 2646 consecutive parturients with sure or ultrasonic dates and no clinical or sonographic evidence of uterine fibroids, polyhydramnios, fetal anomalies or death. The symphysiofundal height was measured with the patient supine, the bladder empty and the uterus relaxed. The accuracy of the method was assessed by the mean simple error, the mean absolute error, the mean simple percentage error, the mean absolute percentage error and the percentage of estimates within ± 10% of the actual birth-weights. Possible factors which may affect the accuracy of the formula were assessed using the Student's t-test at the 95% confidence level. Results: The mean simple error was +44.9 ±377.2g. The mean absolute error was 254.4 ±342g. The simple percentage error [mean ±SD] was 1.7 ±11.6%. The absolute percentage error [mean ±SD] was 7.7 ±8.9%. 76.5% of estimates were within ±10% of the actual birth-weights. There was a slightly significant tendency of the formula to overestimate birth- weights [p=0.05, one-tailed t-test]. The formula was inaccurate in the estimation of the weights of low birth-weight and extreme premature fetuses. Conclusion: The symphysiofundal height [SFH] in centimetres inserted into the formula [SFH]³/ 16 estimates the birth-weight to ±10% of the actual birth-weight in grams in 76.5% of parturients. The limitations of the formula are discussed.

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This is a case report of a small for date Baby who was born at 38 weeks gestation with a birth weight of 2.4kg by emergency caesarian section for contracted pelvis to a 30 year old para¹⁺⁰ mother. Baby was initially admitted with a provisional working diagnosis of cyanotic congenital heart disease with congestive cardiac failure and sepsis to rule out tetralogy of Fallot. Signs presented at birth were very much like those of tetralogy of Fallot. Baby was managed for sepsis and congestive cardiac failure. Baby died 39 hours after admission and autopsy confirmed total anomalous pulmonary venous drainage with atrial septal defect. This is a defect, which is rare and hardly compatible with life. This report therefore is meant to highlight such occurrence despite its rarity and for clinicians to have a high index of suspicion when confronted with such presentation. The case report is also to show the similalrity in presentation with tetralogy of Fallot.

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Aim: To investigate the best time for removal of urethral catheter after retro-pubic prostatectomy for Benign Prostatic hyperplasia (BPH). Patients and Method: All the patients who had retropubic prostatectomy for BPH in a private urological clinic in Enugu, between June 1998 and February 2001, were randomly grouped into two. Group A patients had their urethral catheters removed within 24 hours of the urine being visually clear of blood, and group B patients had their catheters removed within 24 hours after the supra-pubic wound sutures were removed provided that the wound healed satisfactorily. The complications encountered and the length of hospital stay were recorded. Results: A total of 121 patients were studied (60 in group A and 61 in group B). The mean age of group A patients was 68.4 years and that for group B 67.7years. The mean weight of the enucleated prostate in group A was 68.2gm and that in group B was 69.4gm. Associated illnesses and duration of symptoms were comparable in both groups. In group A, out of the 60 patients, 20(33.3%) had one or more complications. There were 28 complications in this group. In group B, out of the 61 patients 4(6.6) had one complication each. The mean hospital stay in group A was 10.1 days while that in group B was 10.7 days. Conclusion: Urethral catheter should be left in place for at least seven day after retro-pubic prostatectomy.

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Background: Low birth weight (LBW), a major contributing factor to neonatal mortality was studied in four major hospitals in four different Igbo-speaking states of Eastern Nigeria - University of Nigeria Teaching Hospital Enugu (UNTH), St. Charles Borromeo Hospital, Onitsha (CBH), Federal Medical Centre Unuahia (FMC) and Mater Misericordiae Hospital Afikpo (MMH) with the aim of determining the LBW rate in this area. Methods: Birth records in the aforementioned hospitals were analysed retrospectively for the years 1991-1995 for consecutive deliveries during the period involved. All babies weighing less than 2,500 grams at birth were regarded as low birth weight, and the incidence among the general deliveries determined for each hospital. Results: The incidence of LBW ranged from 6.66% to 15.26% in the different hospitals. The incidence of LBW was lower at two General Hospitals while higher incidence was observed in training institutions. The average LBW rates were 6.6% at CBH; 8.28% for FMC; 15.26% for MMH and 12.6% for UNTH. Significant differences existed between centers. Conclusion: LBW rates in the Eastern Nigeria compare favourably with reports from other parts of the world. However, the LBW rate is on the increase when compared with figures obtained from the same area a decade and two decades ago.

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Aim: Since quantification is an essential at- tribute of science, an interesting question arose as follows: Are the ages supplied in Laboratory Request Forms reproducible? Methods: A 30-year histopathology data pool containing laryngeal diseases seen among the Igbos of Nigeria was studied with special reference to the reproducibility of the ages supplied successively in two or more Laboratory Request Forms submitted to the Author for childhood papillomas and adulthood carcinomas. Results: Out of a total of 229 laryngeal cases, 10 were repeated biopsies of papillomas while 31 came from adults who were similarly attended to for carcinomas. It was found that reproducibility was 100% in adult females. Conclusions: The adult figures will improve if purposive attention is paid to obtaining each patient's approximate age. Undoubtedly, careful documentation will improve not only the scientific validity of data collected in Epidemiology but also the job satisfaction experienced in Histopathology.

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Objective: To document the result of screening a group of Otolaryngologic patients in Enugu for human immunodefficieacy viras(HIV) infection with emphasis on the clinical features of these patients and the Otolaryngologic diseases that the HIV seropositive patients are suffering from. Patients and Method: A prospective study of patients attending the Otolaryngology service Units at the University of Nigeria Teaching Hospital and Balsam Clinics both in Enugu. These patients were screened for HIV. Results: Thirty patients from a screened 265 patients tested positive to the presence of HIV antibodies in their sera. They were 16 males and 14 females with mean age of 25.2 years. Presentiag disease distribution by anatomic/subspecialty sites is Otology 5, Rhinology 6, Laryngology 11, and head and neck 8 patients. Chronic suppurative otitis media (5), cervical lymphadenopathy (4) and sinusitis (4) are the most common diseases. Conclusion: The most common factor associated with acquisition of HIV infection among our group of Otolaryngologic patients is heterosexual activities followed by foeto-maternal and blood transfusions. HIV infected patients present to the Otolaryngologist with the same disease pattern as the HlV-non-infected patients.

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Objective: To document, analyse and compare the feto-maternal outcome in ventouse extraction and forceps delivery at the University of Nigeria Teaching Hospital, Enugu. Patients and Methods: A retrospective study of records of all cases of vacuum extraction and forceps delivery over a two year period (January 1990 -December 1991) was undertaken. Result: There were 146 cases of both vaccum and forceps deliveries among 4346 total births giving an overall instrumental vaginal delivery rate of 3.4% of total births. The incidence of ventouse extraction was 3.1% and that of forcep delivery was 0.3% of total births. The most common indication was prolonged second stage of labour 56.9%. Facial buising 36.4% and cephalohematoma 14.8% were the commonest complications for forceps delivery and ventouse extraction respectively. Conclusion: Instrumental vaginal delivery especially with ventouse is useful in modern obstetric practice and should be taught and practiced Continued improvement and analyses of those obstetric procedures may help in reducing the high caesarean section rate in Nigeria.

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Aim: To evaluate the sensitivity of Paracheck Pf test in the diagnosis of Plasmodium falciparum (Pf) malaria. Paracheck Pf test is a rapid immunochromatographic dipstick test that detects Pf specific histidine rich protein - II (PfHRP-II) in whole blood. Methods: One hundred patients who presented at the Ebonyi State Teaching Hospital, Abakaliki, Ebonyi State with clinical symptoms indicative of malaria and test positive in the Giemsa thick stain test were also tested with the Paracheck Pf dipstick test. The parasite load was also quantified. Results: Our study revealed a sensitivity of 94%. A higher sensitivity was observed in those patients who presented with a high parasite load (98.8%). The sensitivity was lower (66.6%) when the parasite load was low. Conclusions: The Paracheck Pf Test is simple to perform. It is objective, rapid and easy to interpret. It consequently could be of tremendous usefulness in the rural areas where specially trained health providers are not available and also in the urban areas where malaria is a common scourge in areas of high endemicity.

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Aim: To determine the extent to which cancer of the breast affected young Nigerian women at Enugu. Method: Analysis was based on case notes of 291 Nigerian women, presenting with breast cancer at the University of Nigeria Teaching Hospital, Enugu; between 1990 and 1995. Information of interest in particular were the age of the patients, how soon they consulted doctors and the treatment after histological evaluation of the biopsy specimen removed from the patients. Results: One hundred and thirty-two female patients (45.4%) of 291 analysed were aged 40 years or below. Only 42 of the 132 patients came with early carcinoma of the breast. The rest came with advanced carcinoma of the breast. Fifty one(38.6%) reported to doctors within 6 months of seeing the breast lump, while 81 patients (61.4%) delayed beyond six months, some waited for as long as 24 months before consulting doctors. The commonest histological type seen was invasive ductal carcinoma. These patients had standard surgical treatment for the stage of the disease, except one that rejected surgery. Conclusion: Considering the number of women treated for cancer of the breast in this study, the occurrence of this disease in 45.4% of the young women is high. There were significant delays among these young women before consulting doctors.

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Aim: To examine the effect of isradipine, a member of the dihydrophyridine family of calcium antagonists, on aortic and iliac wall thrombogenicity Materials and Methods: After one week of dosing, the abdominal aorta and iliac artery endothelium was abraded using fogarthy catheter. Aortic and iliac thrombogenicity was assessed, after perfusion in situ, by morphological quantification of platelet deposition using the Baumgartner technique as well as by counting the radioactivity after radiolabeling of autologous platelets with 111 in-oxine. One group of animals (n=8) were dosed for one week with isradipine 0.3 mg/kg. A second group of animals received 50mg acetylsalicylic acid (A.S.A) daily in addition, while a third group received the vehicle only. Finally a fourth group of animals (n=8) were treated with aspirin only. Results: The percentage of the denuded surface covered with contact (unspread) platelets decreased significantly (*p<0.01). From 14.7 ± 2.0 to 9.3 ± 2.1* (6.2 ± 0.8 to 3.7 ± 0.4). The amount of contact and spread of platelets was diminished from 84.9 ± 5.6 to 71.4 ± 4.4* (91.8 ± 5.3 to 75.2 ± 4.6*). Platelet thrombi decreased from 7.4 ± 0.9 to 4.6 ± 1.4* (9.4 ± 1.9 to 5.2 ± 0.7*) in the aorta and iliac artery, respectively. 111 in-oxine Platelet deposition decreased by 39.9 and 41.9%. Concomitant A.S.A-therapy not only abolished the effect of isradipine, but also ehanced thrombogenicity probably as a result of almost complete blockade of vascular PG1₂-production. A.S.A. alone induced an even more thrombogenic action. Conclusion: The result from both methods show that isradipine exerts significant benefits on vascular thrombogenicity most likely via enhanced PG1₂ formation leading to improved platelet vessel-wall interaction. This benefit can be absolished and thrombogenicity even increased by cyclo-oxygenase blockade.

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Aims: To establish the level of awareness of HIV/AIDS among Nigerian long distance drivers and to ascertain their sexual behaviour. Materials and Methods: A cross-sectional survey of 211 male long distance drivers aged between 18 and 65 years was carried out in Enugu State, Nigeria. The survey instrument was a questionnaire with questions pertaining to various aspects of HIV/AIDS including transmission, prevention and sexual behaviour. Results: All the subjects have heard about HIV/AIDS, with most of the initial information (64.9%) coming from the radio. A good proportion (50.2%) had a correct knowledge of the cause of AIDS, and this was found to be directly proportional to their educational attainment. Patronage of female commercial sex workers was high (73.4%), with more involvement in unmarried and younger men. Only 37.4% of the study population made use of condom during casual sex; the most common reason for non-use being that it reduces sensation. Practice of homosexuality was not recorded. Conclusion: The study showed that Nigerian long distance drivers engage in risky sexual behaviour that promotes HIV transmission. More intensive public awareness campaign is required in this target group in order to prevent an explosive AIDs situation in the near future.

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Aim: To establish the baseline extent of diabetic nephropathy in Nigerians with non insulin dependent diabetes and the relationship if any, to other long term complications of diabetes mellitus. Patients and Method: Sixty non-insulin dependent diab-etics who have had diabetes mellitus for seven years or more were screened for proteinuria (using micral stix for microalbuminuria and albustix for macroaibuminuria) on at least 3 consecutive clinic visits at monthly interval. Results: The prevalence of diabetic nephropathy was:- microalbuminuria - 26.67% and macroalbuminuria 23.33%. Prevalence of hypertension, increased with increasing urinary protein excretion (being 30% - normoalbuminuria; 56.25% - microalbuminuria; 78.57% -cicroalbuminuria). Similar trend was also noted for retinopathy being 0% - normoalbuminuria; 12.50% -microalbuminduria, 35.71% -macroalbuminuria for proliferative retinopathy. The prevalence of neuropathy was also noted to increase with increasing urinary protein excretion viz:- 20% -normoalbuminuria; 43.75% - microalbuminuria; 50% - macroalbuminuria for neuropathy. This was however, not statistically significant. Mean creatinine clearance (Crcl) decreased with increasing urinary excretion of protein. It was however noted that diabetic nephropathy was neither age nor duration dependent. Conclusion: This study has shown that a significant number of Nigerian non insulin dependent diabetic patients develop diabetic nephropathy. There is a relationship between abnormal urinary protein excretion and other long term complications of diabetes mellitus.

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Aim: To determine the prevalence and possible reservoirs of Campylobacter species in water samples from different sources in Enugu and Nsukka areas of Enugu State, Nigeria. Methods: Four hundred and eighty (480) samples were obtained from the different water sources, using sterile bacteriological samples bottles following standard protocols. The samples were maintained at between 8 and 15°C and processed within 1 hour of collection. Examination for Campylobacter species was accordingly carried out using a membrane filtration procedure (Celman CN - 6 metrical 47mm/0.45un membrane fitters) using 300ml samples volumes per sources. Butzlers' selective medium was used for isolating and incubation was done by the candle jar method at 42°C. Biochemical characterization of the strains was carried out and species identified by standard micirobiologkal procedures. Results: 146 (34.2%) samples contained Campylobacter spp. Speciation shows the following prevalent rate of isolates: C: jejuni 97 (59.1%), C. Coli 48(29.3%), C. Lardis 14 (8.5%) and C. Faecalis 5 (3.0%). Stagnant waters were most highly contaminated followed by well waters. Tap water was the least contaminated. Conclusions: Water is a reservoir for Campylobacter species and the risks inhabitants are exposed to through these waters are highlighted.

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Objective: The objective of this case report is to highlight the occurrence of a pregnancy in an African woman with untreated Graves' thyrotoxicosis; there being a virtual absence in the literature of reports about similar observations in humans. Case report: Described here is one case of a pregnancy that occurred in a Nigerian woman with unrecognized Graves' thyrotoxicosis. The pregnancy was carried until the 25th week before thyrotoxicosis was correctly diagnosed and antithyroid therapy instituted. Aspects of the course and out-come of the pregnancy relevant to the current understanding of the relationship between maternal thyroid hyper function and foetal development are discussed. Conclusion: It is concluded that the mechanisms involved in the adverse foetal developmental effects of thyrotoxicosis in pregnancy are complex and yet to be fully understood.

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