SUMMARY: Clinicopathological analysis and growth rate study of 100 cases of ameloblastoma was undertaken. The tumour had site predilection for the mandible (91.0%) and occurred more in males than in females (ratio 1:0.9). 62.0% of patients in the series were less than 20 years of age. The estimated monthly growth rate (EMGR) of ameloblastoma was observed to be slower in males although the mean tumour volume recorded in females was lower than males in the series. The biologic aggression of 4 various types of ameloblastoma was predicted using EMGR and average volume of tumour at hospital presentation as predictive markers. Solid multicystic ameloblastoma was observed with the fastest EMGR of 0.81 cm(3)/month. Peripheral ameloblastoma was observed with the slowest EMGR of 0.17 cm(3)/ month. It was concluded that all the 4 types of ameloblastoma observed were clinically distinct and showed varying biologic aggression. The solid multicystic type with the highest growth rate (0.81 cm(3)/month) was considered the most aggressive while the peripheral type (growth rate = 0.17 cm(3)/month) was the least aggressive. It is therefore necessary to distinguish between the various clinical types of ameloblastoma before a clinician proceeds with definitive treatment.

BACKGROUND: Extremity injuries are common in polytrauma, which remains a leading cause of death, long hospitalisation and disability for all ages. There are few research works on the pattern of these extremity injuries in Lagos, Nigeria. OBJECTIVE: To describe the pattern of extremity (limb) injuries in polytraumatised patients. PATIENTS AND METHODS: This was a prospective study carried out at the Lagos University Teaching Hospital, between 1st November 2004 and 31st October 2006. RESULTS: A total of 291 patients presented with multiple injuries between November 2004 and October 2006. All of them had extremity injuries. The studied patients were aged 2 to 76 years with a mean of 31.2 +/- 16.4. Two hundred and twenty two (76.3%) of the patients were aged 40 years or less. There were 219 males and 72 females showing a male to female ratio of 3:1 Road traffic accident was the most common aetiology (73.2%). The most frequently seen fractures were tibia 27.8%, femur and fibula 24.7% each. An overwhelming majority (88.8%) had multiple fractures. The commonest fracture combinations were tibia/ fibula 24.7% and radius/ulna 19.6%. The most frequently associated injury was head injury 26.8%. Others were spinal and abdominal injuries 13.4% each. Hip dislocation accounted for a majority (56%) of all dislocations seen in this study. CONCLUSION: Lower extremity injuries were commoner than upper extremity injuries in polytrauma. Majority of them had multiple fractures especially among bones that have close anatomical location. Head injury was the most commonly associated injury.

OBJECTIVE: To determine the compliance rate, reasons for default and factors affecting compliance. PATIENTS AND METHODS: A prospective study of patients with malignant lymphoma (ML) at the University of Benin Teaching Hospital, Benin City, Nigeria. A total of 190 patients on chemotherapy for ML were followed up for between 6 and 18 months during study period (1995-2003). The reasons for default were recorded. Compliant and noncompliant patients were compared in terms of survival and sociodemographic data. STATISTICAL ANALYSIS: Instat Package system for frequency counts, chi-squares and cross tabulations using Yates correction when necessary and the Fisher's exact test. RESULTS: Noncompliance rate was 63.2%. Major reasons for defaulting were high cost of drugs in 40 cases (33.3%), scarcity of drugs in 29 cases (24.2%) and side effects in 24 cases (20.6%). Compliance was significantly associated with higher levels of education, socioeconomic status, geographical abode (P<0.001) and gender (P= 0.031). Survival was found to be significantly associated with compliance in non-Hodgkin's lymphoma (NHL) (P>0.001) while the relative risk (RR) was below unity in ML. CONCLUSION: The level of compliance with medical therapy is still very poor. Health education and the provision of affordable, accessible and appropriate medical therapy are required. A multidisciplinary approach to improve compliance of patients with medical therapy is advocated.

OBJECTIVE: To determine the incidence and associated risk factors of postpartum depression in a tertiary hospital in Nigeria. PATIENTS AND METHODS: A survey of 206 consecutive women who were 6 weeks postpartum was done, using the Edinburgh postnatal depression scale (EPDS), in a tertiary hospital in Nigeria. Fisher's exact test was used to determine significance between proportions . The Odd ratio and 95% Confidence Intervals were also determined. RESULTS: The incidence of postpartum depression was 27.2%. Preterm delivery was found to be a risk factor for postpartum depression in the study population (P<0.0001, OR=8.0, CI=2.9-22.1). CONCLUSION: It is recommended that the EPDS should be used routinely to screen for postnatal depression in puerperal Nigerian women and that mulltidisciplinary approach involving Obstetricians and Mental health professionals should be adopted in the screening for, and care of women with postpartum depression

OBJECTIVES: To compare selected perinatal characteristics between infants of mothers with reactive and non-reactive antenatal cardiotocography (non-stress test) results. PATIENTS AND METHODS: The medical records of all women who delivered within one week of a non-stress test were retrieved. The indication, test result, gestational age at delivery, Apgar score at 5 minutes, perinatal complications and neonatal ward admission were documented. RESULTS: One hundred and twelve women met study criteria among whom 51 tests were reactive and 61 were non-reactive. Post-datism, intra-uterine growth restriction, hypertensive disorders of pregnancy, and premature rupture of membranes were the commonest indications for the test. Post-datism was more commonly associated with a non-reactive test result. Women with non-reactive tests were almost twice as likely to be delivered by emergency Caesarean section, compared with women with reactive tests; although the test result did not significantly influence the mode of delivery. A non-reactive test was significantly associated with a higher perinatal mortality (p = 0.04). Although the reactive test was associated with a three-fold reduction in the incidence of low Apgar scores compared with the non-reactive test, this difference was not statistically significant (p = 0.18). A non-reactive test was significantly associated with small for gestational age infants (p = 0.01). CONCLUSIONS: Non-reactive non-stress test may be associated with higher perinatal mortality. When appropriately utilised, the test is a valuable tool for early detection of foetal compromise. Antenatal cardiotocography has a place in obstetric practice in low-resource settings for improving perinatal care.

OBJECTIVES: To determine the incidence and pattern of ocular problems of HIV/AIDS at the Guinness Eye Centre Onitsha, Nigeria. METHODS: The case files of all patients who had HIV test at the Guinness Eye Centre Onitsha over a 6-year period were examined. Those who tested positive for HIV were further analysed. Information obtained included patients' demographic characteristics, clinical diagnosis, ocular and systemic co-morbidity, visual acuity and follow-up. RESULTS: Of 1011 patients, 100 (9.9%), 51 males and 49 females, were confirmed HIV-positive. The age range was 21 - 80 years; median -31 years. Fifty-five patients (55%) were or had been married; 45 (45%) were single. Herpetic eye disease constituted 50% of the cases with herpes zoster ophthalmicus accounting for 48%. Bilateral ocular disease occurred in 19 patients (19%) viz: cytomegalovirus (CMV) retinitis (6%); corneal ulcers (6%); uveitis (4%); ocular motor palsy (2%) and ocular gunshot injury (1%). Non-HIV ocular lesions occurred in 20 patients (20%) as follows: bacterial corneal ulcer (8%); globe laceration (6%); non-CMV associated rhegmatogenous retinal detachment, cataract, and secondary orbital tumour (2% each). Systemic co-morbidities were present in 10 patients (10%), namely, emaciation (6%), pulmonary tuberculosis and abdominal malignancy with orbital metastases (2% each). Twenty three patients (23%) had bilateral blindness; 45 (45%) had uniocular blindness; 73.4% of the affected eyes were blind at presentation with 25% having no light perception (NPL). CONCLUSIONS: The incidence of HIV seropositivity doubled in the hospital over nearly 10-year period. Herpes zoster ophthalmicus remains the commonest ocular manifestation although CMV retinitis is becoming common. Since 20% of the patients had non-HIV ocular lesions, eye-health workers are advised to always take universal precautions in order to prevent the spread of the infection within and outside the hospital.

OBJECTIVES: To examine the work and home domain characteristics of anaesthetists in Nigeria, and the impact of these on work and family life. MATERIALS AND METHODS: A total of 200 self-administered questionnaires were distributed to anaesthetists in various health institutions in Nigeria. Of these, 114 (57%) were returned. Information contained in the questionnaire included demographic characteristics, qualification, rank and years spent in the specialty, spouse occupation and details of work and family life. RESULTS: The 114 respondents consisted of 86 males (77%) and 28 females (22.8%), aged between 30 and 59 years. The average weekly working hours were 58.4 hours. About half of the respondents could study anaesthesia at home sometimes, while 25% each could do so always or not at all. About 41% of the respondents could respond to emergencies at home immediately, while 45% could only do so after first reporting to work. Respondents' recommendation to enhance work and family life included reduced work load, more flexible work schedule, accommodation close to place of work, among others. CONCLUSION: Positive impact on service output as well as enhanced job satisfaction will ensue if the recommendations in this study are implemented by the relevant authorities.

OBJECTIVES: To investigate the in-vitro antimicrobial activities of the extracts of Abrus precatorius on some clinical isolates as resistance to available and affordable antibiotics by these pathogens is on the increase. METHOD: In this study the antimicrobial effects of the extracts of Abrus precatorius from leaves, stem and the seed oil were tested against Staphylococcus aureus ATCC 25923, three clinical S. aureus isolates from different sources, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus anginosus (S.milleri), Bacillus subtilis, Corynebacterium spp (toxigenic strain of the mitis biotype), Escherichia coli ATCC 25922, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa as well as Candida albicans using the agar well diffusion technique. Aqueous and methanolic extraction, using the soxhlet extractor was carried out on all plant parts used while petroleum ether was the solvent used to extract the seed oil. To measure the MIC values, various concentrations of the stock, 512, 256, 128, 64, 32, 16, 8 and 4 microg/ml were assayed against the test bacteria. RESULT : At the different concentrations of the extracts used (512 microg/ml - 4 microg/ml), Staphylococcus aureus was the most sensitive organism with an MIC of 8 ug/ml for the leaf extract. Extract from the stem and seed oil were potent against some of the gram-positive bacteria and Candida albicans but not against S anginosus, E. faecalis and gram-negative bacteria tested. The pH of the extracts ranged between pH5 and pH8. This study demonstrates that Abrus precatorius particularly the seed oil has a potent antimicrobial activity. CONCLUSION: The results substantiate the ethno botanical use of different parts of Abrus precatorius for the treatment of various bacteria-related diseases. Topical application of Abrus precatorius extracts in ointments may be recommended especially for treating superficial infections caused by Staphylococcus aureus.

The presence of teeth in newborn is uncommon. Sometimes it occurs, appearing in about one in every 2,000 to 3,000 live births. Natal teeth are teeth already present at time of birth, neonatal teeth erupt during the first 30 days after birth. The normal eruption of the first teeth is quite exciting but their occurrence at birth or few days after birth is quite disturbing because of societal unpleasant reaction towards it in some communities and calls for concern. The majority of natal and neonatal teeth represent the early eruption of normal primary teeth. Less than 10% of natal teeth are supernumerary. Although the majority of natal teeth are isolated incidents, their presence may be associated with some syndromes. Complications include discomfort during suckling causing irritation and trauma to infants tongue, sublingual ulceration, laceration of the mother's breasts and aspiration of the teeth. The objective of the present study was to present a review of the literature on the current information on this topic and give treatment options if necessary.

OBJECTIVE: Third molars have been described as different from other teeth in the oral cavity. They have the highest rate of developmental abnormalities and, most importantly, are last in the eruption sequence. We investigated reasons for third molar teeth extraction in patients attending the outpatient oral surgery clinic of the Lagos University Teaching Hospital, Nigeria. MATERIALS AND METHODS: A retrospective review of patients who had third molar extractions between January 2001 and June 2006 was conducted. Data retrieved and analysed were: age and sex of patients, indication for extractions, type of teeth extracted, technique of extractions (surgical and non-surgical) and angulations of impaction in case of impacted lower third molars. RESULTS: A total of 1763 patients (mean age +/-SD, 33.74+/- 13.3 years; range 15 - 92 years) had their third molars extracted during the period. Majority (58%) of them were females. Surgical extraction was carried out in 506 (28.7%) patients while 1257 (71.3%) patients had non-surgical extractions. Caries and its sequela (63.2%) was the major reason for teeth extraction followed by recurrent pericoronitis (26.3%) and periodontitis (9.2%). Only 11 (0.6%) cases were removed for prophylactic reason. Patients who had their teeth removed for caries were significantly younger than those for periodontitis (P=0.000) but older than those for pericoronitis (P=0.000). CONCLUSIONS: Caries and periodontal diseases occurring in relatively older age group were the major reasons for non-surgical extraction of third molars while recurrent pericoronitis occurring in relatively younger age was the major reason for surgical extraction of impacted third molars. Prophylactic surgical extraction of third molars is not a common practice in our environment.

OBJECTIVE: To describe the spectrum of histopathological features of thyroid diseases; analyse the occurrence of each of the types and to compare the findings with those from previous studies done in Nigeria and elsewhere. MATERIALS AND METHODS: A retrospective study of thyroid lesions seen at the OAUTHC Histopathology Department during a 10-year period between 1988 and 1997. RESULTS: The 274 surgical thyroid specimens received during the study period came from 235 (85.8%) females and 39 (14.2%) males giving a female: male ratio of 6:1. Colloid goiter accounted for about 75% of cases with an average age of occurrence of 40.7 years. Only 1.8% showed features of toxic goiter and thyroiditis each. The adenomas constituted about 6% while carcinomas constituted about 11% of cases respectively. Adenomas occurred almost a decade earlier than carcinomas. Follicular carcinoma was the commonest thyroid cancer seen in this study. CONCLUSION: This study shows that the commonest thyroid disease in Ile-Ife is colloid goiter, which is a preventable disease. Thus, public health measures such as iodination of salt and health education are called for to reduce the occurrence of this disease.

BACKGROUND: Bilateral visual loss following chronically raised intracranial pressure is not uncommon especially in developing countries. However, this calls for concern when the cause of the raised intracranial pressure is neglected pyogenic cerebral abscess. CASE SUMMARY: A sixteen year old male student presented to our unit with eight months history of recurrent headache associated with early morning vomiting. He developed bilateral visual loss a month prior to presentation. He had sought treatment at several herbal homes and orthodox hospitals before presentation. His cranial computed tomographic scan (CT) showed a massive peripheral contrast enhancing lesion in the frontal lobes with gross midline shift and other evidence of mass effect. He subsequently had craniotomy and excision of the mass. Intraoperative and laboratory findings confirmed the lesions to be abscess. He had ciprofloxacin and metronidazole for four weeks. He had uneventful postoperative period though his visual loss has persisted. He is being followed up in the clinic. CONCLUSION: This patient illustrates that untreated frontal lobe abscess could cause bilateral visual loss from chronically elevated intracranial pressure (ICP). Even though this should be rare in contemporary neurosurgical practice, ignorance and poverty which are rife in developing countries will be important contributory factors. Physicians working in developing countries should be aware of the symptomatology of cerebral abscess and raised ICP. They should encourage patients to do cranial CT when the features are suggestive of space occupying lesions.

Typhoid intestinal perforation is a common complication of typhoid fever in our environment. The occurrence of multiple intestinal perforations that involves both small and large bowel is increasingly being seen in our practice. We report a case of 32 intestinal perforations in a child. This is the highest number of perforations seen in any 1 patient in our search of the English literature. This article details our approach to management of this type of patient.

OBJECTIVE: To draw attention to primary hyperparathyroidism as a cause of severe hypertension. RESULTS: A 47 year old Nigerian male presented with headache, occasional blurring of vision and dyspnoea on mild exertion of 2/12 duration. He had been troubled by painful osteoarthritis of the knees for 2 years for which he was taking NSAIDs. He was found to be severely hypertensive, BP 210/130mmHg and had bilateral knee crepitus. BP was resistant to control on Nifedipine R and Moduretic. Serum urea, creatinine, uric acid were normal but there was hyperacalcaemia and hyperchloraemia. Haematological indices, urinalysis, microscopy and culture of urine were normal. Parathyroid hormone level was raised. A parathyroid MIBI scan study showed an extensive area of significance towards the inferior pole of the right lobe of thyroid medially with a second area of very low significance medial to the left pole. These findings indicated the presence of a right inferior parathyroid adenoma. He had parathyroid surgery and a large adenoma in the right inferior gland and a smaller left inferior gland were removed and confirmed histologically. Corrected calcium and parathyroid hormone levels dropped to normal, and the BP was easily controlled with Lisinopril 5mg daily subsequently. He is not currently on antihypertensive medication two years post surgery. CONCLUSION: This case highlights the need for thorough investigation of cases of hypertension to exclude specifically secondary causes, which in some cases may be endocrine in origin and may easily be corrected.

The incidence of dextrocardia with or without situs inversus is rare though the true incidence in Nigeria is not known. Plain films are the preliminary investigations of choice in diagnosis of situs anomalies. The aim of this case report is to emphasise the importance of recognition of the spectrum of situs anomalies, because the altered anatomy associated with these anomalies may result in confusing imaging findings, misdiagnosis and difficulties with treatment when seen in conjunction with acquired abnormalities of the chest and abdomen. This study also aim to emphasise the need for accurate placement of radiographic markers by the radiographers before exposure of the films as the key for identification of situs anomalies. The case of dextrocardia without situs inversus diagnosed in a 4-month old baby boy who also had bilateral undescended testis and bilateral polydactyl of hands and feet is presented. The imaging modalities for assessment of situs anomalies are discussed.