Background: For the Surgeon, enteric perforation Is the most dreaded com plication of typhoid fever. Despite the numerous surgical methods described for It's operative treatment , the availability of newer potent antibiotics against the pathogen, and the vast research efforts directed at combating this disease of poverty, the mortality rate from typhoid Intestinal perforation has remained dismally high. Aim: The present study was directed at Identifying the magnitud e of this surgical condition In the northwestern part of Nigeria. Method: A 5year retrospective audit (January 2001 December 2005) of all hospital admissions of typhoid enteritis seen In the Usmanu Danfodiyo University Teaching Hos pital (UDUTH), Sokoto. Cases of intestinal perforation were subsequentl y extracted and further analyzed in detail.. Results: Out of 295 cases of clinically diagnosed enteric fever, 27 (9.2%) were managed under the surgical services of the hospital for typhoid intestinal perforation. Among those who were surgicall y treated, 21 (78%) were males and 6 (22% ) were females, representing a male: female ratio of 4:1 . The modal age was the second decade. The duration of symptoms prior to hospital presentation ranged between 3 and 28 days. The average dela y In the hospital before emergency operative treatment was 2 days. All the perforations Involved the terminal Ileum of which the majority was single (56%). Simple closure was done In 78% of cases, resection and primary end-to-end anastomosis In 15% and Intestinal exteriorization In the remainder. The mortality rate was 33%. Conclusion: Besides public health measures directed at the prevention of this disease, early hospital presentation and a minimum preoperative delay after arrival may reduce the dismally high morbidity and mortality rates that still attend typhoid enteric perforation In our sub region.

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Aims: The study was aimed at documenting the types of non-traumatic orthopaedic disorders at Egbe, Nigeria. Methods: A retrospective study of 176 non-traumatic orthopaedic disorders were operated at ECWA Hospital, Egbe from September 1990 to December1993. 109 (61 .9%) patients were males and 67 (38.1%) patients were females with male to female ratio of8:5. Results: The commonest non-traumatic orthopaedic disorders were chronic osteom yelitis, ulcers, pyomyositis, tuberculosis and abscess (66.7%) and the rest non-traumatic orthopaedic disorders was 33.3% of all the cases. The commonest congenital disorders were congenital talipes equinovarus (11.4%) Ganglion and elephantiasis take 10.8% of all non-traumatic orthopaedic disorders. Bone tumours (2.8%) and knee deformities (1 .5%) were very uncommon in our series. Conclusions: Reduction of Infective causes of non-traumatic orthopaedic d isord ers will reduce drastically the cost of orthopaedic treatment In Nigeria since treatment of non­-traumatic orthopaedic disorders such as osteoarthritis' of the hip , which are expensive are uncommon in Nigeria.

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Background: Adequate health facilities are lacking in rural areas in the world. The International College of Surgeons (ICS) has embarked on surgical outreach programs to address this lack . Aim: To present a recent experience of Rural Surgery Outreach in the Niger Delta Area of Nigeria. Materials and Methods: From November 2002 to March 2005, surgical teams comprising surgeons and anaesthetists, with support from sponsors visited pre-arranged medical facilities in the Niger Delta Area to assess and treat patients with ailments amenable to surgery within the context of available facilities. Announcements through community leaders and the radio were used to reach the people In the area to be visited informing them of the date and location of the outreach service. Operating times were from 1Oam to 7pm. Anaesthetic techniques used were local infiltration, spinal and Total Intravenous Anaesthesia (TIVA). The medical officer of the facility reviewed the patients the next day and was to report any complications. Results: Six surgeons, one obstetrician and 2 anaesthetists part(cipated in the outreach. There were 3 sponsors. Five centers were visited In Akwa lbom ' and Rivers States, but surgical procedures took place in only 4 centers. Out of a total of 720 patients, 380 (52.8%) were screened, and of these 215 (56.6%) had surgical ailments. Seventy (70) operations were carried out on 68 (31 .6%) patients. Of those who had surgery, there were 51 males, and 17 females (M :F ratio 3:1), with ages ranging form 3 to 75 years (mean 43.3 years). There was one report of a huge haematoma following repair of a huge inguina-scrotal hernia. Conclusion: The program, though challenging, Is a worthy one and If maintained, would enable delivery of surgical care to disadvantaged communities.

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Objectives: To compare the effectiveness of Diazepam and Promethazine for oral premedication In children undergoing tonsillectomy and/or adenoidectomy under general anaesthesia. Method/Design: The effect of oral premedication was Investigated In a double blind, randomized trial in 85 children. The children were randomly allocated to one of three group! . Group 1 received promethazine and placebo. Group 2 received diazepam and placebo while group 3 received two placebo preparations. Sedation scores for the 3 groups were com pare.: before leaving the ward for the operation room and also In the recovery room. Other parameters such as Induction scores , compliance and sedation scores were also compared. Results: Following premedication with diazepam none of the patients was anxious, crying or distressed on leaving the ward compared with 2!28 In the promethazlen group and 5/28 in the placebo group. More patients (25/28; 89%) were calm and quiet on arrival in the operatinfl room following diazepam than following promethazine, (12/28; 43%). Conclusion: Diazepam compared with promethazine Is a more effective oral premedicant for children

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Background: The unavailability of endoscopy facilities in most Health Institutions in Nigeria as well as the lack/high cost of non-invasive screening tests for H. pylori makes evaluation and management of dyspepsia a difficult task . This study was undertaken to determine the sensitivity of presumptive clinical judgment in making diagnosis of the various causes of dyspepsia. Methods: The study was conducted between December 2002 and May 2004 .Two hundred and three adult dyspeptic patients referred to the gastroenterology unit of AKTH for endoscopy were recruited. Upper gastrointestinal endoscopy was performed on each patient using a fibre-optic Olympus GIF Q-40 forward viewing video endoscope and histological for presence of Helicobacter pylori was done using Haematoxylin and Eosin, and Eosin, and modified Geimsa stains. Results: The mean age of the study subjects was 37.7 + 13.5 years with the highest frequency in the 30-34 year age bracket, with a male to female ratio of 1 .16:1 . There was no significant association between sex and type of dyspepsia, P value > 0.05.There was also no significant association between type of dyspepsia and duration of dyspeptic symptoms (P value >0.05).Anorexia and weight loss were found to be significantly associated with presence of organic dyspepsia with P values < 0.05.Clinical evaluation was sensitive in predicting duodenal ulcer, gastric cancer and gastro-esophageal reflux disease but is fraught with over diagnosis and symptom overlap. Conclusions: Certain symptomatologies such as anorexia and weight loss may be pointers to underlying organic lesions for dyspepsia. However clinical evaluation alone is fraught with mis-diagnosis and symptom overlap.

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Background/Aim: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV!AIDS ) Is gradually rising to an epidemic level In Nigeria and could be a leading cause of death In the most productive age group of the economy. Otorhinolaryngological manifestations occur frequently in these patients bringing them In contact wit h t he Otolaryngologists.This study is to evaluate the prevalence of these manifestations amongst them. Patients and Methods: This prospective study was carried out among HIV!AI DS positive patients evaluated for otorhinolaryngological feat ures of the disease at the Otolaryngological clinic of the University of llorin Teaching Hospital , llorin , Nigeria between January and September 2004 . Results: Twenty three (23 out of he t went y nine (29 ) patients evaluated for otorhinolaryngological features had otorhinolaryngological manifestations (78%). T he age range was otorhinolaryngologicalfrom 2 years and 70 years with a mean of 32.5 years and a peak age of 20 to 4 9 years (65% ). The male/female ratio was 1 .6 to 1 .0.Most of these patients were students (58.2% ) and identifiable risk factors of unprotected heterosexual contacts, drug addictions and lack of usage of protective devices against the scourge was only possible I n only 16 .7% of them. Commonest lesion was oralioropharyngeal candidiasis (52.18% ) ; Nasal {Chronic rhinosinusitis , (17.39%)}; Otological {Sensorineural hearing loss (13.04%)}; cervical lymphadenopathy (13.04%) and laryngologlcal { Epiglottitis (4.35%)}. Conclusions: Otorhinolaryngologlcal manifestations were found In 78% of these patients. The common lesions were oral/pharyngeal candidiasis , chronic rhlnosinusitis, and sensorineural hearing loss with cervical lymphadenopath y In that ord er. Clinicians es peciall y otolaryngologists should have a high level of suspicion of HIVIAI DS Infections in patients with these features In their day-to-day practice.

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Aims/Background: Urinary tract infections in children remain worrisome with attendant high morbidity. Methodology: This was a 4- year retrospective study of 5364 urine microbiological results from patients aged less than 16 years In a tertiary Institution. Results: One thousand and one hundred (20.5%) showed significant bacteriuria with bacterial pathogen isolated. Escherichia coli (40.3%) and Klebsiella species (26.2%) constituted the most common bacterial pathogens responsible for infection in both gender; Proteus species was predominate among the males. The age and gender distribution showed high prevalence among the females 592(53.8%) compared with the males 508( 46 .2%), with peak Incidence of Infection In the age group 1-4 years and from 5 to 16 years in the females. The antibiotic sensitivity pattern of the bacterial isolates showed similar pattern reported In other studies, with reduced sensitivity to the frontline antibiotics used in treatment of urinary tract infectlon. Conclusion: We conclude that proper evaluation of urinary tract infections deserve regular surveillance study in different hospital settings with basic microbiologic facilities. This is essential for early detections in changes concerning aetiological agents and the antibiotics sensitivity patterns.

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Objective: To determine the Incidence and sociodemographic factors associated with various adult leukaemia subtypes In a tertiary hospital In, Nigeria. Patients and Methods: A total of 190 patients with a diagnosis of leukaemia seen over a 12-year period (1990-2002) at the University of Benin Teaching Hospital , Nigeria were studied. They were analyzed In the context of gender, marital status, geographical abode, educational and occu pational status. Results: There were 70 males and 120 females with a male-to-female ratio of 1:1.7. Chronic lymphocytic leukaemia (CLL) was the more .frequent variety (31 .6% ) . Gender , marital status, geographical abode, occupational status (P = 0.0001) and educational status (P=0.0036) were significantly associated with the various types of leukaemia. Chronic leukaemias were more common In married and widowed patients while acute leukaemias were much more common in unmarried patients. All the leukaemia subtypes were more common In patients who resided in Delta state, a major oil producer. Majority of the patients with acute leukaemia were students while those with chronic leukaemia were in the lower socio­ economic classes. Conclusion: Poverty and illiteracy are additional problems with patients with chronic leukaemias. Living In Delta State where the petrochemical Industries and gas flare sites are located may be a risk factor for the development of leukaemia.

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Carcinoma of the cervix Is one of the commonest malignancies In Nigerian women, with majority of the patients presenting at the advanced stage of the disease. The care of advanced cases Is palliative mainly with Radiotherapy. We present a case report of Internal Iliac artery ligation In advanced carcinoma of the cervix with significant reduction in symptoms and signs

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