The presentation shows how a victim of fall from height in the bush can sustain a penetrating chest injury by falling on a dry stick of a shrub. Application of the principles of management of penetrating chest injury is needed despite the grotesque clinical appearance.

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Background: Individuals react differently to stress and there is a general feeling that the much needed relaxed disposition among educational administrators has been on the decrease. This study therefore examined how some demographic variables affect the perception of the various schools stressors by educational administrators in Edo state of Nigeria. Materials and methods: A random sample of 17.6% of educational administrators participated in the study (22 males and 38 females). The instrument of the study was constructed by the researcher and titled school management stressors (SMS). Results: Both male and female administrators perceived the stressors in the same way. Age of the administrators affected the way the stressors are perceived. The stressors that affected the administrators most were: students indiscipline, energy demand, crowded classrooms and inadequate provision of funds by the government. Conclusions: The supervising bodies should take cognisance of the above findings and find ways of ameliorating them. This will loosen the burden on the administrators and bring about the much needed efficient management of schools.

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Aim: To test, in our environment, the hypotheses that-the ascending testis is a real and common variant of testicular maldescent, and that testicular maldescent is rarely congenital in the absence of a complete hernial sac. Patients and Methods: All 29 patients who presented to the authors with testicular maldescent over a 5-year period were studied. They underwent 29 orchipexies. Results: In 9 cases the testes were indicated to have been palpable in the scrotum at birth or in early childhood. Of these, at orchiopexy, 2 (22.22%) had associated hernial sacs while 7 (77.88%) had no associated sacs, but fibrous remnants of the processus vaginalis were identified in their spermatic cords. In 20 cases in which the testes were indicated to have been undescended at birth, 17 (18%) had associated complete hernia sacs at orchiopexy while none had fibrous remnant of the processus vaginalis in the spermatic cord. Conclusion: The hypotheses were found to be true in this environment.

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Aim: To determine the pattern of change of red bloodcell in appropriate-for gestational - age (AGA) preterm babies in the first twelve weeks of life. Patients and Methods: All consecutive healthy preterm new born babies delivered at UNTH and admitted into the hospital NBSCU were included. Serial haematological determinations were carried out at birth- 24 hours, 48-72 hours, 1 week, 3 weeks, 6 weeks and 12 weeks. Results: The average values of hemoglobin and hematocrit at birth Were 150g/L and 0.46L/L respectively. These values fell progressively to 68g/L and 0.26L/L at six weeks of age, with a marginal increase to 89g/L and 0.27L/L respectively at twelve weeks. At birth, the reticulocyte count was 2.2% and at twelve weeks it was 1.3%. Conclusion: In the first week of life, hemoglobin concentration and hematocrit levels of less than 120g/L and 0.3L/L respectively should be considered as anemia. This should be investigated and treated appropriately.

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Aim: To assess the knowledge and attitude of the Christian clergy towards sex education of young people. Materials and Methods: A cross sectional study of 200 clergymen was carried out in Enugu metropolis making use of a self-administered sturctured questionnaire. Results: The ages of the respondents ranged from 20-65 years (mean 35.2 with standard deviation 8.99). One hundred and seventy four (87.0%) of the priests had adequate knowledge of sex education and 191 (95.5%) supported the idea of providing sex education to young people. One hundred and fifty five (77.5%) supported the involvement of the church in providing sex education to young people. The most appropriate age of introducing sex education to young people according to them was 15-19 years. Ninety-eight (49.0%) of the priests advocated that males and females should be given sex education together while 102 (51.0%) felt that it should be done separately. The best institutions for providing sex education according to the priests were the family (49.7%), school 47 (23.6%), church 38 (19.1%) and others (8.0%). Conclusion: The support of Christian clergy in Enugu to sex education of young people was unanimous, although they had reservations on the scope and method of its presentation. The clergy should be target for training and properly integrated in sex education programmes.

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Aim: To determine the profile of acne keloidalis nuchae amongst Nigerians and to document the various treatment modalities undertaken by these patients prior to presentation at our dermatology clinic. Patients and Methods: A retrospective study of patients with acne keloidalis nuchae (AKN) at the University of Nigeria Teaching Hospital Enugu, from 1993 to 1998 was undertaken. This was supplemented by a further prospective study on 23 patients to clarify issues not documented or highlighted by patients' folders. Results: 203 out of 7.861 new patients with skin disorders seen within the study period had AKN. The prevalence was 2.6%. The rash was discovered accidentally in 43% of cases. 89.9% discovered the rashes between the ages of 15-40 years. 3 (1.5%) affected females had in addition irregular menstrual cycles and infertility. Acneiform eruptions occurred in 63.2% whilst the lesions were already fibotic with keloid-like papules/plaques in 76.3%. The eruptions were distributed commonly in a band- like pattern along the posterior hairline in 97.3% and 19.7% had keloids elsewhere whilst seborrhea was a common finding in 63.5%. The treatment with the use of native concoctions, caustic chemicals and traumatic physical modalities was a common observation. Conclusion: The pattern of acne keloidalis nuchae in Nigerians is similar to that reported in the western literature, except for significant proportion of males presenting at the fibrotic phase with massive keloids initially. Crude local treatment is to be discouraged to reduce secondary infection and keloid formation.

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Aim: To determine the incidence and outcome of cardiac arrest during general anaesthesia at the University of Nigeria Teaching Hospital Enugu, Nigeria. Patients and Methods: A retrospective study Of 6,450 anaesthetic charts from January 1994 to December 1996 was undertaken. The cases where cardiac arrest box had been ticked were retrieved and reviewed. Information sought for included patiens age and sex, pre-operative physical status of the patient, and whether surgery was emergency or elective. These data were analysed. Results; Twelve cases of cardiac arrest were recorded giving an overall incidence of 18.6 in 10,000 anaesthetics. Ten patients were successfully resuscitated while 2 died. The incidence of cardiate arrest was significantly higher in patients with American Society of Anaesthesiologists (ASA) grade 3 or poorer, and in patients for emergency surgery. Conclusion: The study showed that poor patient selection and the timing of surgery are significant factors in cardiac arrest during anaesthesia. Anaesthetists are, therefore, advised on proper pre-operative evaluation and preparation of patients.

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Injuries to the human eye by the pecking of birds are very rare. However, apart from the dangerous ocular infections e.g. with chlamydiae psittaci which pet birds can transmit to human-beings, there is also the potential for serious ocular injury when they attack human-beings. In this paper, I have reported a case of a pecking eye injury by a hen in a 3 year-old Gambian boy.

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The International Association of Oral and Maxillofacial Surgeons (IAOMS) is committed to quality patient care. The education of oral and maxillofacial surgeons has, however, been in constant evolution ever since the inception of this specialty; and this state of flux reflects the dynamic expansion of its scope. Oral surgery has a unique relationship with medicine and dentistry as it straddles both professions. To understand this dynamic expansion, it is pertinent to review the present scope of oral and maxillofacial surgery. Today an oral and maxillofacial surgeon's training includes management af trauma, surgical reconstruction of acquired and developmental deformities, temporomandibular joint surgery, dentoalveolar surgery, preprosthetic surgery including implants, management of odontogenic infection, management of oral pathology, and administration of general anaesthesia and sedation. The oral and maxillofacial surgeon routinely treats patients with systemic diseases such as acute and chronic alcoholism, diabetes mellitus, hypertension, cardiovascular and pulmonary disease, adrenal excess or insufficiency, renal and hepatic disease, neurological problems, as well as drug abusers.¹ The new requirement for oral and maxillofacial surgery training programmes is 48 months with rotations in anaesthesia, medicine, and surgery, and a minimum of 30 months in the oral and maxillofacial surgery service.² Eighteen months of off-service rotations, most or all of which are taken at an intern or resident level instead of medical student or clerk level, give oral and maxillofacial surgery (OMFS) residents high-quality medical education. Their rotation on general surgery and surgical sub-specialties results in a broad exposure to the conclepts and principles of surgery beyond that provided by the oral and maxillofacial surgery rotation. It is the dental education that differentiates oral and maxillofacial surgeons from other surgical specialties; therefore formal dental education culminaing in a D.D.S or D.M.D. degree is strongly encouraged. It is most desirable that this formal dental education be complemented by formal medical education culminating in a medical degree.¹

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Aim: To study the presentation of herpes zoster (shingles) in self-referral urban primary care setting. Patients and Methods: During nearly 20 years, patients of Igbo ethnic group presented with herpes zoster, on a self-referral basis, to my urban, week day, evening, out patient clinic. The recorded epidemiological parameters were studied retrospectively. Results: The affected 28 patients consisted of 19 males and 9 females (M:F of 2:1). They were aged between 11 and 74 years (average 46.6 years). Most males were aged between 30 and 49 years whereas the females clustered between 50 and 69 years. Only 2 children were infected, adults being mostly attacked. Sixteen patients were living in Enugu and its suburbs, while 12 patients came from dispersed towns. For 6 patients, their first attendance was for this ailment, the rest having registered earlier between one month and 13 years. Sixteen patients manifested left-sided lesions, the remaining twelve being right-sided. Affliction of the thoracic dermatomes preponderated with as many as 18 instances. The only case of second attack (4% incidence) occurred within an interval of 10 months. During the roughly equal periods of 1983-92 and 1993 - 2002, the total sufferers were 9 and 19 respectively. Regarding possible antecedents, a sole male, who was put into a Police Cell by a rival Taxi Union, stayed in it for 3 days and developed the rash 2 days after regaining his freedom. Conclusion: Confirmatory of world-wide literature are the following Igbo findings on herpes zoster: it is a disease of adulthood; it attacks thoracic dermatomes predominantly; it is probably increasing in incidence; it shows no clear evidence of seasonal incidence; and it manifests repeat affliction in about 5% of patients. As to the future, prospective local studies should determine its possible association with AIDS.

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Aim: To assess the psychosocial problems encountered in parenting sickle-cell children in Enugu. Method: The subjects include all (parents, guardians, foster parents of sickle-cell children) who have the responsibility of caring for sickle-cell children and who have attended the sickle-cell clinic of the UNTH between June-August 1999. Data was gathered using a structured questionnaire which tapped information on (a) sociodemographic variables (b) psychosocial consequences of parenting sickle-cell children and (c)coping mechanisms adopted by parents in alleviating these psychosocial consequences. Results: There were 72 (64%) females and 40 (36%) males. Most of the respondents were married (75%). 57% were self employed. Psychosocial problems in the areas of marital and interpersonal relationships as well as income and other areas of psychosocial functioning were found to be high. Conclusion: Special psychological services should be rendered to parents with sickle-cell children to help reduce the increasing psychosocial difficulties asociated with parenting these children.

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Aim: To critically assess the proportion of the abdominally performed hysterectomies that could have been done vaginally. Patients and Methods: A retrospective chart review of 283 elective hysterectomies performed at the University of Nigeria Teaching Hospital, Enugu, over a 5-year period, was undertaken. Results: The ratio of elective abdominal to vaginal hysterectomy during the study period was 2.4:1. Vaginal route was used exclusively for genital prolapse while the abdominal route was used for all the other indications. There was a high incidence of moderate to severe intrapelvic adhesions associated with large uterine fibroids, making a case against the use of vaginal route in such cases. Conclusion: It is feasible to reduce the ratio of abdominal to vaginal hysterectomy by employing the vaginal route in smaller sized fibroids and other benign uterine conditions.

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Aim: To report, on the outcome of positional therapy on women presenting with infertility and found to have retroverted uterus. Method: After sexual intercourse and seminal ejaculation, the woman assumes a prone position with elevation of the thighs on a pillow for 30 minutes or more. Results: All the five women so diagnosed and treated, had successful pregnancy and delivery. Conclusion: Positional therapy is recommended in any woman presenting with infertility and found to have a retroverted uterus.

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Aim: To collate information on the aetiology, concomitants, pathogenesis and management of micro albuminuria to guide in patient management. Methods: An English language literature search using Medline (1991-2000) was done to assess research/review articles on micro albuminuria. The study design and quality were assessed, with particular attention to subject selection, definition of outcome variables, and applicability of the results to management of patients at risk. Results: Micro albuminuria refers to a urinary albumin excretion of 30-300mg/24hours. Timed collection is the gold standard for research into albuminuria but an albumin: creatinine ratio is sensitive and specific enough. Large variations however occur in urinary albumin excretion rates. Micro albuminuria is associated with systemic hypertension, diabetes mellitus and other clinical states. Microalbuminurics have a higher prevalence of hyperlipidaemia, coronary artery disease, peripheral vascular disease, myocardial infarction and stroke. Conclusions: Many studies have demonstrated the association of microalbuminuria with cardiovascular risk factors. The mechanism of albuminuria and organ damage is still not clear. Anti hypertensives such as angiotensin converting enzyme-inhibitors and calcium channel blockers have a beneficial effects of lowerimg the degree of micro albuminuria.

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Aim: To ascertain the extent nurses have prepared hospitalised patients on catheter self-care. Method and Materials: A purposive sample of 30 hospitalised patients on indwelling urethral catheter was interviewed using resarcher-developed instrument. Result: The subjects, a group of trauma patients with spinal cord injury and/or fractured limbs/pelvis were mostly long-term catheter users. Only two subjects could assume total catheter self-care, while most (86.7%) could just initiate measures to ensure high fluid intake. All the subjects reported using nurses and nonprofessionals for their catheter care. Although most subjects (90%) perceived health education on catheter care as a nursing duty, they received minimal, vague or no instructions from them. Conclusion: These subjects were not properly assessed and assigned appropriate systems of nursing care. Nurses need to be clear about the content of their patient teaching in catheter care and assume full responsibility in teaching them.

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Aim: To assess the general trend which might highlight reasons for poor blood pressure control in post postpartum eclamptics. Method: A retrospective study of 77 eclamptics managed at the University of Nigeria Teaching Hospital, Enugu. Blood pressure was measured on admission, immediate pre-delivery, immediate post partum, 1-6 hours, 6-24 hours, daily for 10 days and one reading after ten days. The blood pressure readings were analysed. Results: Postpartum blood pressure trends showed two nadirs and two peaks. The second peak occurred at 6 days postpartum. Corresponding to the two peak periods, approximately 32% of the exlamptics developed blood pressures that were higher than their pressures on admission. The mean time for the blood presure to normalize at 140/90 mmHg was 6 days. In approximately one-third of the study subjects, the blood pressure either rose, or did not fall, between admission and the 8th day postpartum. There was a statistically significant negative correlation between the regression coefficients and the blood pressure on admission, blood loss at delivery and a significant positive correlation between the regressions and the total number of fits. Conclusion: The results suggest a possible explanation for late postpartum seizures in hypertensive patients as well as a place for the use of diuretics in the control of resistant postpartum hypertension in eclamptics.

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Aim: To evaluate the usefulness of mitomycin-C as it relates to modern techniques in the prevention and treatment of recurrent pterygium. Patients and Methods: Patients with pterygium and recurrent pterygium were enrolled. Patients' personal data including age, sex and surgical history were noted. The exclusion criteria applied were failure to comply with at least 6 months of follow-up, and patients whose primary surgeries were performed in centres not included in the study. Included also was a retrospective study of patients who had pterygium excisions with the same surgical technique but without application of any adjuvant. Results: A total of 28 patients satisfied the inclusion criteria. Eighteen of them had surgery for the first time and 15 had re-surgery after initial excision with 5-fluorouracil. A total of 33 eyes were operated upon as 5 of the patients had surgery in both eyes. The recurrence rate was 12.0%. For comparative analysis, 32 patients were studied retrospectively with recurrence noted in 20 (62.5%) of them. Conclusion: The rate of recurrence in this study was found to be low with application of low dose mitomycin-C during bare sclera pterygium excision. Without any application, recurrence rate was observed to be as high as 62.5%. This procedure has been found to be simple, affordable and effective.

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Aim: To conduct a sanitary inspection of wells in Enugu so as to identify the system deficiencies that could pose risk to the health of the users and to compare the contamination risk factors of the wells in different areas of the town. Materials and methods: The study was conducted in Enugu metropolis in 1998. Using a multi-stage sampling method, 75 wells were selected and inspected using an 11-point risk-assessment scale recommended by WHO. Relevant information was obtained through observation, measurements using metal tapes and by interviewing the owners/users of the wells. Results: All the wells were shallow with a mean depth of 7.2 ± 2.1 metres. Up to 13 (17.3) wells had no/inadequate concrete lining less than 3 metres. All had no/inadequate apron and parapet. Five wells (6.7%) had faulty drainage channel within 2 metres. A quarter of the wells had wooden/no cover and in 65 (86.7%) wells, water is drawn using any available container. Twenty- three (30.7%) wells were located within 10 metres of a sewage contamination source. The contamination risk scores of the wells significantly differed in different parts of the town. Conclusion: All the wells had between 3 to 6 potential contamination points and none may be devoid of pollution. Adequate health education of well constructors/users is recommended so as to minimise the health hazards posed by the present uninformed practice. The government should set up a water supply surveillance agency within the health ministry.

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Aim: To review the incidence, aetiology and management of intestinal obstruction at the University of Nigeria Teaching Hospital (UNTH) Enugu. Patients and Methods: A retrospective review of all patients admitted into UNTH, diagnosed and treated as intestinal obstruction, over a 5 years period (January 1989 to December 1993). Results: Ninety five (95) cases were recorded during the study period, made up of 62 males and 33 females. The main causes of obstruction were adhesions (58), volvulus (11), intussusception (10) and hernias (9). Seventy seven patients were managed for acute obstruction while 18 were managed as subacute obstruction. Large bowel obstruction occurred in 15 patients (15.8%) and small bowel obstruction was recorded in 80 patients (84.2%). Surgical intervention was carried out in 79 patients (83.2%) while 16 patients (16.9%) responded to conservative management There was no mortality. Conclusion: The pattern of small bowel obstruction at the University of Nigeria Teaching Hospital Enugu is similar to that in the west though that of large bowel obstruction maintains the African pattern. This is probably due to the tertiary nature of the institution since only very intractable cases are referred.

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