Aim: To study the patterns of recurrence of carcinoma in mastectomy scars. Methods: A 30-year retrospective analysis was carried out as regards surgical specimens . of mastectomy scars received by the author from numerous surgeons working in several hospitals with special reference to patients of the Igbo ethnic group. Results: During 1970-2000, 45 Igbo women developed recurrent disease after undergoing mastectomy for carcinoma. They were aged between 24 and 67 years, the average being 44.6 years which is similar to 45.3 years reported from Japan. Disease free interval ranged from 3 months to 7 years. Incidentally, a woman, who was free for 10 years, presented with three painful nodules, which were excised for presumed recurrence “ but these turned out not to be cancerous but considerable scar tissue associated with abscesses, calcific materials and disintegrated sutures. The youngest Igbo patient, aged 24 years, was of the same age as the youngest sufferer in a Swedish series. Interestingly, this same age featured in a historical case of recurrent breast cancer reported way back in 1876. Conclusions: Surgical specimens received from 20 surgeons working in 13 hospitals situated in 9 towns provided a wide enough spectrum for epidemiological comparison with world-wide publications. It is concluded that the research is in agreement with two needs expressed in the literature, namely, “cancer of the breast (should be) evaluated and treated in a rather stable community” and “there is need for international comparative .studies.”

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Aim: To investigate the determinants of teenage pregnancies in a rural community. Method: A household survey was conducted; 359 girls aged 10- 19 years, were randomly selected, and using the WHO/EPI cluster sampling method for immunization coverage, were interviewed using interviewer-administered semi-structured questionnaire. Information was sought on their socio- demographic status, age of sexual debut, use of condoms, pregnancy and its outcome and the “Osu” caste system. In addition focus group discussions were held with teenage girls, older mothers, adolescent males and older fathers. Data was analysed with Epi -INFO software version 6.0 for the household survey and manual content analysis was done for the focus group discussions. Results: About 263(73.2%) were single, 210(58.5%) were currently enrolled in schools, 186(51.8%) were Protestants and 46.0% Roman Catholics. The mean age at first sexual intercourse was 14.3 years (SD 2.2) and rate of ever - use of the male condom by their sex partners was 40.9%. The prevalence of teenage pregnancy was 163(45.4%). Teenage pregnancy was significantly associated with age, occupation, no education, early marriage, religion and practice of “Osu” caste system. While 115(70.9%) of the pregnancies ended in live spontaneous vaginal delivery, 27(16.4%) had induced abortion, 9(6.5%) caesarean section and 12(7.3%) ended in stillbirth. Male condom is misused. Conclusion: Better education on the proper use of the condom and programmes to enlighten teenagers on reproductive health issues is advocated, while efforts to change unhealthy cultural values and practices with appropriate 1EC activities should be made.

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The third stage of labour can present with very serious complications which may lead to severe morbidity or mortality unless prompt and decisive action is taken. Post partum haemorrhage (PPH) is the commonest third stage complication and a leading cause of maternal mortality and morbidity in our environment. This review is aimed at revisiting the predisposing factors to post partum haemorrhage. It also emphasizes the prophylactic, immediate and further management of emergent cases. Apart from refreshing our memories on the recent techniques of management where state of the art facilities are available, it also provides alternative non sophisticated methods that can be life saving.. Management of PPH in some religious sects like the Jehovah's witness and Faith healers are also highlighted.

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Aim: To determine and evaluate the levels of nitrate and nitrite in some commercial infant formula in view of the health implications of these factors. Method: Nitrate and nitrite, which may create significant health problems in infants, were determined in four commercial infant formula. The public health and toxicological implications of high consumption of these factors are briefly highlighted. Results: Nitrate varied from 6.0 to 168.0mg/kg, while nitrite was from 0.00 to 0.026 mg/kg. On the bases of dafly intake estimates, levels of nitrate and nitrite in the infant formulas seem to satisfy the current acceptable daily intake (ADI) and pose no health risks. Conclusion: In view of the high sensitivity of young infants, nitrates and nitrites should be determined more often particularly in water and infant foods.

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Objective: To compare the rates, indications and complications of caesarean section in twin and singleton pregnancies. Methods: A retrospective comparative analysis of caesarean sections done for twin and singleton pregnancies at the University of Nigeria Teaching Hospital, Enugu, Nigeria, over a six-year period. Differences in variables between the two groups were compared by means of the t-test or chi-square test as appropriate at the 95% confidence level. Results: During the study period, 314 twin and 10753 singleton deliveries were conducted in the hospital. The caesarean section rate (36.6%) for twins was significantly higher than the rate (21.9%) for singletons (p = 0.00). The leading indication for ‘twin’ caesarean section was previous section while that for singleton caesarean section was feto-pelvic disproportion. There was no maternal death in the twin caesarean section group while 15 maternal deaths occurred in the singleton group (i.e. a maternal death rate of 6 per 1000 sections). The maternal morbidity was also less in the twin than in the singleton group because more of the latter were complicated cases. The perinatal mortality rates were 26 and 63 per 1000 for the twin and singleton caesarean sections respectively. The perinatal mortality rates were lower in the caesarean delivered twins than in the vaginally delivered ones. Conclusions: The above demonstrate that timely caesarean section has an important role to play in minimizing feto-maternal risks associated with t in pregnancies. Practitioners should, therefore, not hesitate to resort to caesarean section in twin pregnancies if called for.

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Objectives: To determine the patterns of utilization of Maternal Health Services (MHS), (antenatal clinic, delivery and post-natal services) and willingness to stay in a maternity waiting home (MWH) by women. Methods: A pre-tested questionnaire was used to collect information from 393 adult women from rural and urban communities on their experiences at last pregnancy and delivery. Findings: The majority of the women used MHS, and age, educational level, parity, social class and place of residence of the women statistically significantly explained this. Long waiting hours, perceived high cost of services, lack of drugs, negative staff attitude and inaccessibility, were the common reasons given for non-utilization of MHS. Conclusion: Women use MHS when available. However, charges for MHS need to be subsidized, as many women do not use these services because they cannot afford them and MWHs should be made part of formal MHS, in order to reduce maternal morbidity and mortality.

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Aim: To review the aetiology, clinical features, investigations and treatment of bacterial cystitis in females. Materials and Methods: A medline search was carried out and the literature reviewed in line with the aims for meaningful findings. Results: Bacterial cystitis is classified into uncomplicated and complicated varieties. Uncomplicated cystitis occurs in an otherwise healthy patient without structural or functional abnormalities in the urinary tract. Complicated cystitis occurs in compromised patient with structural or functional abnormalities that enhance infection acquisition and reduce efficacy of therapy. Bacterial cystitis occurs with varying frequency in females from the neonatal period to old age. Conclusion: Bacterial cystitis is a common and distressing, clinical problem in females, and may be recurrent especially in young women or those with urinary tract anomalies. Risk factors exist, with some being preventable. An appreciation of predisposing factors, aetiopathogensis, diagnostic and treatment modalities are useful. Preventive strategies need to be emphasized in our environment.

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Aim: To highlight the tragedy posed by unbooked obstetric emergencies. Method: All the obstetric deaths in the year 2000 were recorded. Analyses were made of such aspects as distribution of death according to booking status, major direct obstetric causes of death, state of mother and baby on admission, duration of stay and mode of delivery in hospital before death occurred, and source of admission of the unbooked mothers. Results: In a period of 12 months from January 1 to December 31, 2000, a total of 1809 mothers delivered at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt. One thousand five hundred and sixty two (86.3%) were booked while 247 (13.7%) were unbooked. There were 18 maternal deaths; 2 among the booked mothers and 16 among the unbooked mothers, constituting a maternal mortality ratio of 128 and 6,478 per 100,000 deliveries respectively. The combined maternal mortality ratio for both booked and unbooked mothers was 995.0 per 100,000 deliveries. The major avoidable social factor in maternal mortality here is the lack of antenatal care and also the unorganized maternity referral system in Port Harcourt. Conclusion: Any intervention to reduce maternal mortality here should be directed towards eliminating poverty, illiteracy and ignorance which are the major factors that create the unbooked mothers.

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Aim: To sensitize health professionals in general and medical doctors in particular on the need to pay adequate attention to childhood psychiatric disorders, to highlight the problems associated with the management of such disorders and to point out the existing prospects for their proper management here in Enugu. Method: Four cases of childhood psychiatric disorders presenting to a general psychiatrist in Enugu are reported with details of the mode of presentation, possible aetiological factors, and the kinds of treatment offered as well as the results of psychiatric management. Results: The four cases show the different kinds of problems encountered in the management of childhood mental disorders here in Enugu. The main problems include : delay in referral to the psychiatrist; a convoluted pathway to care in childhood psychiatric disorders; sociocultural influences on orthodox care; inconsistent treatment and follow-up; the role, and lack of it, of doctors and other health professionals in facilitating early intervention; iatrogenic complications and lack of expertise in the field of child psychiatry. Conclusion: It is of paramount importance that doctors of all specialties and health professionals should be aware of the problems encountered by families and children suffering from mental disorders. The need for early intervention and/or referral to the psychiatric cannot be overemphasized.

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Aim: To highlight the importance of biomedical engineering, with respect to the many basic amenities including adequate water supply, electricity, drugs and medical equipment necessary for the proper functioning of medical doctors which are totally lacking in most developing countries. Method: Review of biomedical engineering and the implication of lack of its development in health care delivery. Result: While a properly organised and equipped traditional hospital engineering service may effectively provide for adequate water supply and electricity, as well as other ancillary services, the design, research and production or innovative and functional medical equipment fall under the basic function of biomedical engineering which is not yet constituted in most developing countries. Conclusion: For an effective, smooth-running, total health care delivery system especially in the developing countries, the importance of constituting, nurturing and development of the discipline of Biomedical Engineering cannot be over-emphasised. Consequently an objective, pragmatic and result-oriented policy geared towards training and manpower development - both in academic research and applied production engineering relevant to optimal medical practice should be pursued with utmost vigour.

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Background: Haemorrhage during prostatectomy is a significant cause of morbidity and mortality. Anaesthesia may influence the degree of haemorrhage during these operations. Aim: To assess the difference in blood loss between spinal and general anaesthesias. Material and Methods: Patients assessed fit for prostatectomy at the University of Port Harcourt Teaching Hospital (UPTH) and some private hospitals were alternately allocated to either general or spinal anaesthesia for the procedure. All the surgeons were based in the Urology Unit of UPTH. The intra-operative blood loss for each patient was assessed by the gravimetric method and was compared under spinal anaesthesia (SA) and general anaesthesia (GA). The blood pressure, ECG and Oxygen saturation were monitored. The enucleated prostate glands were weighed. Results: Eighty consecutive patients in two groups of forty each were included in the study. There was no conversion from one form of anaesthesia to another. The mean blood loss with GA (Group A) was 829 ± 15 ml (range 450-1100 ml) while that for SA (Group B) was 526 ± 25 ml (range 300- 700 ml). Using the student t-test, the difference between the two groups was statistically significant (P<0.05). The study showed a 36.6% intraoperative blood loss under SA less than that from GA. The mean weight of prostate in Group A was 72.4g ± 8.2 (mean ± SD) while it was 84.6 g ± 7.5 (mean ± SD) in Group B. There was no correlation between blood loss and the weight of the gland removed. Conclusion: The anaesthetic technique is of relevance in reducing intraopera five blood loss. Reduced blood loss will consequently reduce the risks of allogeneic blood transfusion.

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Background: Fetal distress has significantly contributed to the rising caesarean section rate, which is as high as 20-25%. Caesarean section for clinically diagnosed fetal distress has been criticized as being unjustified in many instances. Objectives: To assess the fetal outcome in women delivered by caesarean section following a clinical diagnosis of fetal distress and to determine the accuracy of this diagnosis. Methods: A retrospective analysis of the case notes of 126 parturients delivered by caesarean section for clinically diagnosed fetal distress at the University of Nigeria Teaching Hospital (UNTH) Enwga over a two-year period. Results: Forty six (36.5%) babies had Apgar scores of 7 and above, while 80(63.5%) had Apgar scores lower than 7, including 5 (4.0%) fresh stillbirths. The caesarean section rate in the hospital during the period covered by this study was 19.9% and fetal distress contributed 2.3% of this rate. The perinatal mortality rate was 39. 7 per 1000. Conclusion: Clinical diagnosis of fetal distress is accurate in about two-thirds of cases and wrong in the remaining one-third. Electronic fetal heart monitoring, fetal scalp blood sampling and fetal pulse oximetry should be provided by health care managers to improve diagnosis of fetal distress and minimize unnecessary caesarean sections. Though this study demonstrates the limitations of using clinical parameters alone in the diagnosis of fetal distress and in the selection of cases for caesarean section; however, in the absence of such modem facilities, clinical diagnosis is still useful, otherwise about two-thirds of such babies might perish.

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A fifty year old Nigerian Igbo woman presented with subacute combined degeneration of the cord, hyperpigmentated spots on the palms and soles, white eye lashes, grey hairs, clonic-tonic convulsions and heart failure. She had had intractable anaemia despite multiple blood transfusions and hematinics for more than two years. Subsequent clinical observations and investigations showed the patient to have pernicious anaemia (PA). This metabolic anaemia is considered rare in the Africans and florid multi-organ involvement has rarely been reported in the African. It is however associated in the blacks with high morbidity and mortality due to the fact that the illness is often misdiagnosed and patients present late for diagnoses and treatment. In the case of our patient, the clinical course was reversed with vitamin B₁₂ treatment. The protean clinical presentations, the use of available and affordable investigations and the dramatic response to parenteral vitamin B₁₂ therapy are presented.

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Peripartum heart disease is worldwide in distribution but appears most commonly in multiparous black women with a low socioeconomic background¹. Hypertensive disorders associated with pregnancy can be classified into three groups:- Chronic, transient and pre-eclamptic hypertension². Whereas chronic and transient hypertension do not affect the outcome of pregnancy appreciably, pre-eclampsia presents a potential danger to the mother and fetus. Cardiac failure among pregnant northern Nigerian Women has been reported to occur more frequently in the postnatal period³. Hypertensive cardiac failure has been seen in pregnant women in our practice, but none was seen in association with labour. In a series, only 1.13% of the women with heart disease developed heart failure during labour We report a fatal case of hypertensive heart failure in labour from our centre.

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Aim: To evaluate an immunochromatographic assay method in the serodiagnosis of tuberculosis. Patients and Methods: Thirty participants, 25 patients and five normal individuals were studied between July and October 2001. 40μL, of whole blood or 20μL of serum was used in the test for each kit. Using sputum smear microscopy as gold standard, the new method was compared with x-ray diagnosis Results: The sensitivity, specificity and efficiency of the new immunodiagnostic method were 89.5%, 77.7% and 85.7% while that of X-ray were 75%, 50% and 66.6% respectively. Conclusion: The new immunodiagnostic method gave better results in sensitivity, specificity (as well as in other performance indices) than X-ray diagnosis. The new test is rapid, reliable and field operable.

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Retained foley suprapubic catheters are a common occurrence in urologic practice. The gold standard is to remove the catheter by minimally invasive methods, with as little discomfort to the patients as possible and without leaving any fragments of latex, which could form a nidus for calculus formation. The procedure described uses a 10 ml syringe and needle passed through the lumen of the catheter to puncture the inner surface of the catheter balloon and thus deflate it. Because the catheter balloon does not burst in this procedure there is no risk of balloon fragmentation or subsequent stone formation. The technique is very simple, does not need any expensive equipment like ultrasound machine or ureteric stents, It causes the patients little or no discomfort and has been found to be effective in most cases.

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Objective: To establish the serum zinc levels in Nigerian children in the first six months of lactation. Materials and methods: This was a cross sectional study. Serum zinc levels were assessed in 120 healthy breast fed infants in the first six months of lactation. Atomic absorption spectrophotometer was used for the analysis. Results: The average serum zinc level obtained is 1.21ug/ml. Conclusions: The mean serum zinc level obtained is appropriate for the infants as their growth was satisfactory and no signs of zinc deficiency were noted.

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Aim: To elucidate the non-drug related factors involved in the unique actions of ivermectin and the disassociation between plasma ivermectin concentrations, the commencement of microfilaricidal effects and adverse events. Methods: A willing and consenting patient group was matched for dermal microfilariae and plasma ivermectin concentrations in our laboratory. The patients (20 in number) were skin snipped; treated with ivermectin ( 150 μg/kg of body weight) and further skin snipped every 12h for 72h. Simultaneous blood sampling was performed' to establish ivermectin concentrations in plasma. Adverse events were recorded for three days after dosing, Results: Plasma ivermectin peaked at 4h (44.0±2.9 ng/ml) and latency to ivermectin effect was Tin. There was an initial increase (over 12h) in the skin load of microfilariae (mf)from 47.6±2.5 mf/mg skin to 52.2±2.4 mf/mg skin followed by a decline over the next 60h. After 72h, plasma ivermectin concentrations and skin microfilarial densities declined to <10ng/ml and <5mf/mg, respectively. Adverse events were mainly of the Mazzotti type. Conclusion: Although ivermectin in single oral doses has shown considerable promise in the treatment of onchocerciasis, further investigations of the complexities outlined above are advocated.

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