A 20-month old girl presented with an intralingual cyst from birth, which interfered with feeding but not respiration. The cyst was completely excised and histology of the wall showed an epithelial lining of stratified squamous and respiratory type epithelium. There has been no recurrence and function of the tongue has remained normal.

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The objective of this paper was to determine different patterns of Lactate Dehydrogenase(LD) isoenzymes in serum, pleural effusions and ascitic fluid collections and their usefulness in the differential diagnosis of malignant and non-malignant diseases. It was a case control study carried out at the Lagos University Teaching Hospital. Forty- six patients with pleural or ascitic fluid collection (male and female, age range between 18 and 65 years) made up of Twenty-two patients with malignant diseases and twenty-four with non- malignant diseases were recruited. Control group comprised 50 apparently healthy subjects of both sexes with age ranging between 18 and 65 years. Serum, pleural and ascitic fluid collections were assayed for total lactate dehydrogenase(LD) and it s isoenzymes. Total LD was estimated using the pyruvate to lactate reaction. LD isoenzyme analysis was estimated by cellulose acetate electrophoresis and stained with formazan. The mean total serum LD activity in the disease groups (malignant and non-malignant) was significantly higher than the mean total serum LD activity in the control group. The pleural fluid LD was highest in patients with empyema thoracis. Five isoenzymes of LD (LD1 - LD5) were present in both control and patient sera. The serum LD1 and LD2 isoenzymes were predominant in the controls. The serum LD4 and LD5 isoenzymes were predominant in the disease groups (malignant and non-malignant). LD4 and LD5 were the predominant isoenzymes in both pleural and ascitic fluids obtained in malignant and non-malignant diseases. Serum LD4 was significantly higher than serum LD5 in non-malignant disease while serum LD5 was significantly higher than serum LD4 in malignant disease. The types of malignancies could not be differentiated by serum and effusion fluid LD isoenzyme pattern. Pleural fluid total LD estimation is useful in monitoring patients on chest tubes and may be used to determine when to insert them. Serum LD4 and LD5 differentiates malignant from non-malignant disease but the effusion LD isoenzyme pattern does not.

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The carriage rate of Hepatitis-B surface antigen (HBsAg) in an urban community in Jos, the Plateau State capital, was studied to obtain the pattern of Hepatitis-beta virus (HBV) spread within the community. HBsAg screening was performed on a consecutive sample of 524 apparently healthy individuals (293 males and 231 females) aged 15-65 years who voluntarily turned up for the survey. Fifty-four (10.3%) were HBsAg positive by ELISA. The carriage rate in females 30/231 (13.0%) was significantly higher than in the males 24/293 (8.2%) (p<0.05). In relation to age, 14/144 (9.7%) were aged <20 years, 11/121 (9.1%) were 21-30 years, 7/115 (6.1%) were 31-40 years, 14/89 (15.7%) were 41-50 years, 2/27 (7.4%) were 51-60 years and 6/28 (21.4%) were >61 years. In relation to marital status, carriage rate was highest among the divorced/widowed group (12.5%) followed by the married group (10.6%). Carriage rates in relation to occupation showed that infection was highest among traders (13.7%) and students (13.2%). The survey therefore confirms the endemicity of HBV infection in Jos and describes the groups that are at risk. This calls for health education of the general population on preventive measures to check the spread of the virus in the community.

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Episiotomy continues to be a frequently used procedure in obstetrics despite little scientific support for its routine use. The incidence of episiotomy and perineal tears and also the indications for episiotomy were therefore investigated in 1007 singleton deliveries between January 1, 1997 and December 31, 1997 at the Lagos University Teaching Hospital. The incidence of episiotomy was 54.9% of all deliveries. Episiotomy was more frequently performed in primipara (90.4%). Perineal tears occurred in only 18.8% of all deliveries, with majority in the multipara (93.6%). Most of the team were of first degree (98.4%). No third degree tear was recorded. The commonest indication for episiotomy was that of protecting the perineum from possible tears (80.7%). All the episiotomies were mediolateral. Episiotomy rate was higher among deliveries conducted by doctors. Performance of episiotomy had a positive correlation with increasing foetal weight. No major complication or maternal death attributable to episiotomy was recorded. The results of our study suggest that the use of episiotomy can be restricted to specified indications like instrumental and big babies delivery. It is also useful for the prevention of maternal morbidity through perineal laceration. Randomized control trials will however be necessary to clarify the controversies relating to restrictive episiotomy.

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Sixty-seven final year medical students of the Obafemi Awolowo University, Ile-Ife, Nigeria were questioned to find out the influence of undergraduate education on their choice of future career. Eighty per cent of them found anaesthesia interesting and important but none would pick anaesthesia as a first choice for future career. One-third of the students studied did not even consider it. The students made several suggestions on how to improve undergraduate medical training. The author also suggests measures for general improvement in all aspects of anaesthetic practice in Nigeria with a view to attracting more residents into this specialty.

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A clinical study was carried out between January 1996 and December 1997 in Iwo Nigeria to determine among others the types and frequency of occurrence of side-effects of anti-tuberculous drugs in the 8-month regimen recommended by the Nigerian National Tuberculosis Control Programme Committee (NTCP) for newly diagnosed (ND) Pulmonary Tuberculosis (PTB) cases. This was compared with a 6-month regimen used within the same population of ND PTB subjects at Iwo Nigeria. 65 (13%) of the 500 patients in group one on the 8-month regimen had various side-effects while 7 (14%) of the 50 patients in group two on the 6-month regimen manifested various side-effects. The side-effects rate and frequencies were similar and in both, they were mild and did not materially lead to major change of the anti-tuberculous medications. The regimen used in this study in group one (NTCP recommended) and group two recorded low incidence of side-effects. It confirmed that Directly Observed Treatment Short-course (DOTS) when applied with the recommended regimen by the Nigerian NTCP is effective and is characterised by low and minor side-effects.

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Head injuries are a universal problem and they constitute a major public health problem both in terms of morbidity and mortality. The aim of this study is to examine the causes and pattern of fatal head injuries in the Lagos University Teaching Hospital (LUTH). A retrospective autopsy study of fatal head injuries in LUTH between January 1993 and December 1997 was done by retrieving autopsy reports, extracting relevant information and analysing them. Two hundred and fourteen such cases were reviewed (7% of all autopsies during that period). Majority were consequences of road traffic accidents (52%) and assault (12%). Adults between the ages of 21 and 40 years were the most affected (44%), followed by children 10 years and below (17%). Seventy seven percent of all cases were males. Common lesions identified include skull fractures (73%), intracranial haemorrhages (69%), lacerations and contusions (31%).

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We studied the efficacy of a home-made urease test (HUT) in the detection of Helicobacter pylori (HP) infection in patients undergoing upper gastrointestinal endoscopy. In the first phase of the study, two antral biopsies each were obtained from 43 patients for urease tests using the CLOtest and a home-made buffered 2% urea solution with phenol red as indicator at pH 6.8 (2% HUT). Twenty-six patients (60.5%) were HP positive, both by the 2% HUT and CLOtest with 100% concordance. In the second phase of the study three antral biopsies each and blood were obtained from 42 patients for the determination of HP status using a 10% HUT and a combination of culture and serology. Twenty-three patients (54.8%) were HP positive using the 10% HUT, while 32 patients (76.2%) were positive using the combination of 2 tests. Compared to this the sensitivity and specificity of the 10% HUT were 72% and 100% respectively. The CLOtest produced a colour change in a shorter time than the 2% and 10% HUT (median 1 hour versus 10 hours versus 16 hours p < 0.0001). In the third phase of the study, we observed that by doubling the biopsy size, the time required to obtain a colour change was significantly reduced (median 4.5 hours versus 10 hours p < 0.05). The HUT is easy to prepare, cheap, sufficiently sensitive and it is reliable enough to start treatment when positive. With 100% concordance and 1% the cost per test when compared to the commercially available CLOtest; the 10% HUT is hereby recommended for the detection of UP infection in our region.

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Lack of basic health data for monitoring and evaluation of health services continue to affect the planning, implementation and evaluation of health services in Nigeria. This has contributed to the poor health status and inefficient health services in the country. In the primary health care management information system (PHCMIS), Voluntary Village Health Workers (VHWs) and Traditional Birth Attendants (TBAs) are responsible for collecting information at the community/village level. Trained research assistants administered a pretested semi structured questionnaire and filled an observation checklist to all the voluntary health workers in Akinyele LGA of Oyo State in a cross-sectional survey conducted to assess their record keeping practices as well as their knowledge of and attitude towards it. Results showed that almost half of the respondents had no formal education and a similar proportion had been VHWs for between over 10 years. Over eighty per cent knew the uses of record keeping for monitoring and evaluation purposes. Their attitude towards it was positive and almost all felt it was easy to keep records. Ninety six percent keep records of their health activities and most forward them. It was observed that only 11 (10.8%) respondents had the VHW/TBA record of work produced and recommended by the Federal Ministry of Health because they were reportedly not supplied to them. The factors that were associated with record keeping practices were positive attitude towards record keeping, duration of work as a VHW/TBA, prior training on record keeping and receiving feedback on records kept. Recommendations made included periodic training and retraining of the VHWs on record keeping, ensuring consistent supply of record forms and providing regular feedback on records kept to the VHWs.

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The pattern of intracranial neoplasms in Ibadan Southwestern Nigeria appears to have evolved over three decades since the establishment of neurosurgical facility in 1962. Metastatic tumours to the intracranial compartment were the commonest neoplasms (23%); choriocarcinoma and multicentric involvement of the brain in Burkitt s lymphoma accounted for the great majority of the metastases. Well-differentiated glial tumours are now being increasingly recognized in Ibadan, Nigeria. Glial tumours accounted for 20% of neoplasms, second in frequency to metastases. Pituitary adenomas and meningiomas accounted for 17.1% and 11.4% respectively. Germ cell tumours are however uncommon in Ibadan Nigeria having a low frequency (1.4%). A notable difference exists in the tumours found in children and adults. Astrocytomas accounted for the largest single group of neoplasms in children while metastatic tumours are the dominant group in adults. Continued improvement in neurosurgical facilities may improve diagnosis and cause more tumours to be verified histologically. This will contribute to the evolving pattern seen in Ibadan Southwestern Nigeria.

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Epilepsy is one of the commonest disorders presenting the neurological clinics in developing countries. There are attendant complications especially in untreated or poorly treated cases. In this article, we report an uncommon complication known as Landau-Kleffner syndrome in a Nigerian girl. The syndrome, typically seen in children consists of an acquired aphasia frequently associated with clinical seizures and paroxysmal electroencephalographic (EEG) accompaniment. There had been no adequate neuropathlogical correlations to explain the symptomatology; thus, various forms of pathogenesis have been ascribed to the syndrome. The clinical seizure is easily controlled by an antiepileptic; but speech recovery is variable, and this is usually poor in cases presenting one or two years after onset.

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