The Objective of the study is to investigate foetal growth curve amongst the women attending the antenatal clinic of the UBTH and determine if the gravidogram needs to be customised for use in our community. Five hundred and sixty booked antenatal patients with certain last menstrual period dates were recruited for a prospective non-randomised longitudinal study. Serial measurement of the symphysis-fundus at each antenatal clinic visit was taken using a non-stretch tape measure in centimetre. The data collected was analysed for the mean longitudinal growth curve, and for the construction of a centile gravidogram (10th, 50th, 90th percentile) using a computer programmed ready-to use chart. The mothers average height and body mass index was 1.64m +/- 0.06 and 25.9+/-4.24. The mean birth weight was 3.13kg +/- 0.49. The male infants were 46.3% of the total and were slightly heavier (weight boys vs. girls, 3.15 vs. 3.11kg, P=0.467), not fetal growth curve is comparable and draws a parallel with international standard gravidogram, except that our babies grow all through pregnancy. The foetal growth pattern in Benin is comparable to international standard pattern. However, because of infant birth weight and maternal biosocial differences there is need to costomise the gravidogram to identify all at risk babies in the community.

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The effect of a three-minute exercise step test (submaximal) on the recovery of tidal volume (V(T)), respiratory frequency (f(R)) and minute ventilation (V(E)) has been investigated in non-asthmatic subjects, asthmatic subjects that exercise regularly and asthmatics that do not participate in regular exercise. Recovery was observed over twenty minutes at two-minute intervals. Ten male non-asthmatic subjects (NAS) (mean age 20.7+/- 0.4 yr), six male asthmatic subjects (20.5+/- 0.5 yr) that exercised regularly (EAS) and six male asthmatic subjects (20.8+/- 0.5 yr) that did not exercise regularly (NEAS) were studied. Exercise significantly increased all the measured variables in all the groups of subjects (P<0.001 in each case). At the end of the 20th minute, magnitude of recovery of V(T) was 123.3+/- 4.5% in NAS, 102.4+/- 5.1% in EAS (p<0.001) and 87.9+ 5.4% in NEAS (p<0.001). Mean rate of recovery of V(T) was highest (6.3%/min) in NAS and least in NEAS (4.4%/min). At the end of the (T)observation period, recovery of respiratory frequency (f(R)) was 100.0+/- 5.0% in NAS, 100.0+/- 4.5% in EAS and 89.2+/- 3.0 in NEAS. Mean rate of recovery of f(R) was 5.0%/min in NAS and EAS subjects respectively and 4.4%/min in NEAS subjects. Also, at the end of the 20th minute, the magnitude of recovery of V(E) was similar between NAS and EAS (105.1+/- 1.5% and 101.6+/- 1.75% respectively). Recovery of V(E) was significantly less in NEAS (93.9+/- 2.5%; p<0.01). Mean rate of recovery of V(E) was similar between NAS and EAS subjects (5.0%/min in each case) and 4.1%/min in the NEAS subjects. Thus regular exercise improves the recovery of ventilatory parameters in asthmatic subjects.

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Two hundred and eighteen men with confirmed urethritis were investigated for Ureaplasma urealyticum at the Special Treatment Clinic, University College Hospital, Ibadan between 5th January and 28th December 2000. Sixty-four (29.35%) of the 218 patients had gonococcal urethritis whilst 154 (70.65%) had non-gonococcal urethritis (NGU) out of which 22 (14.3%) had U. urealyticum urethritis and 10(6.5%) had Trichomonal urethritis. The difference in the occurrence of U. urealyticum between the patients and the control group was highly statistically significant (p<0.001). The age range of peak incidence among the patients investigated was 20-29 years. There was evidence of urethritis in all the 22 U. urealyticum positive cases as shown by the presence of increase in the number of polymorphonuclear leucocytes in the specimens collected. A significant difference in the nature of the urethral discharge in men with gonorrhoeae compared with U. urealyticum positive NGU patients was also demonstrated. Treatment of those patients found to be positive for U. urealyticum with a course of oral Tetracyline was successful but then the problems posed by the asymptomatic Ureaplasma urethritis still remained unanswered.

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The aim of this paper is to highlight areas in which urologists collaborate with other healthcare practitioners and to identify further areas of beneficial collaboration. A review of the literature using Medline search and the authors clinical experience. There is close collaboration with the radiologists in urological investigations and embolization of tumours, aspiration of cysts and abscesses as well as obtaining biopsy specimens. Cross referral of patients occurs between urologists, gynaecologists, oncologists and radiotherapists. Technological advances enabling different specialist to master certain procedures like ultrasonography and laser surgery should make collaboration obligatory and mandatory. Collaboration also occurs with orthopaedic, paediatric and plastic surgeons, proctologists and specialist nurses involved in urological treatments. Sometimes, there have been competition and conflicts with the above specialists, especially the gynaecologist in the treatment of urogenital fistulae. Close co-operation among healthcare practitioners will improve the standard of practice to the benefit of the patient as well as to promote healthier work atmosphere in health care delivery. Conflict and competition are diversionary, costly and unnecessary. The urologist appears best placed to lead the way in collaborative clinical practice in this millennium.

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A retrospective analysis of cases of caesarean section performed in Jos University Teaching Hospital between January 1994 and December 1998 was undertaken to determine the incidence, indications, perinatal and maternal outcome. There were 11,571 deliveries with 2083 caesarean sections done giving an incidence of 18%. 62.2% of the patients who had caesarean section were booked for antenatal care and delivered in the hospital, while 37.8% were unbooked seen as emergency. 90% of the operations were done as an emergency while only 10% was electively performed. There was a high caesarean section rate in all the age groups as well as the various parity distributions. The main indications for the elective section were repeat caesarean section, placenta praevia, precious baby, severe pregnancy induced hypertension and bad obstetric history while those for emergency section were cephalo-pelvic disproportion foetal distress, repeat caesarean section, antepartum haemorrhage, severe pregnancy induced hypertension/eclampsia, obstructed labour and breech presentation. The maternal mortality rate was 624.1/100,000 due mainly to haemorrhage, eclampsia and sepsis and there was one anaesthetic death amongst the booked patients. The perinatal mortality rate was 81.6/1000. The clinical causes of deaths were birth asphyxia, ante-partum haemorrhage, obstructed labour and prematurity.

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A total of 135 obstetric patients who were first-time transfusion recipients at the University of Maiduguri Teaching Hospital were studied with respect to the incidence and clinical severity of urticarial transfusion reactions (UTR) in relation to the number of previous pregnancies. The overall incidence of UTR was 12.6%. Analysing the data with respect to the number of previous pregnancies the incidence of UTR were 0%, 0%, 3.8%, 8.3%, 21.7% and 37.5% among patients with 0.1, 2, 3.4 and 5 previous pregnancies respectively. However, all cases of UTR in the affected patients were clinically mild, manifesting with urticarial rashes and pruritus without any features of anaphylaxis. This data would suggest that the risk of UTR increases with the number of previous pregnancies. Therefore, multiparous patients need closer observation during transfusion therapy.

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In recent times, our experience in the chemotherapy of Burkitt's lymphoma patients in Ibadan, Nigeria has been that of poor outcome, hence this study was undertaken to determine the factors leading to the poor results of chemotherapy of Burkitt s lymphoma in Ibadan. A retrospective analysis of Burkitt s Lymphoma patients seen over eleven year period, between January 1987 to December 1997 at the Paediatrics and Haematology Departments of the University College Hospital, Ibadan was carried out. There were 67 patients, mean age 11+5 years (range 4 to 30 years), 42 males, 25 female giving M:F ratio of 1.7:1. Majority of the patients (76.2%) were stage D, only 4.5% were stages A and of the 67 patients, only 57 (83.6%) had chemotherapy, 40 of whom had COAP, 8 had COMP and 9 patients had either cyclophosphamide or cytosar as monotherapy. Only 22.8% of patients that received chemotherapy went into complete remission. In this study, we observed a declining overall complete remission rate of 22.8% (compared to 47% in 1979) in Burkitt s Lymphoma patients. The presence of large amount of fake drugs in the Nigerian market may imply that some of the cytotoxic drugs used in these patients could have been fake drugs. We suggest that the government should subsidize the therapy of these patients as well as eradicate the presence of fake drugs in the market, thereby increasing the chances of a cure.

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The objective of this paper is to assess the visual outcome and complications associated with anterior chamber lens implantation. A retrospective review of all patients who had anterior chamber lens insertion at St Mary s Catholic Eye Hospital Ago-Iwoye between October 1998 and October 1999 was made. Follow up was from two months to one year. 14 eyes of 14 patients had anterior chamber lens implantation. The mean age was 62.6 years. Indications for surgery included, uncorrected uni-ocular aphakia 28.6%, inadvertent posterior capsule rent 14.2%, and uncomplicated extra-capsular surgery 57.1%. 50% of the patients had best corrected post-operative acuity of 6/18 or better. Post-operative astigmatism was minimal. The observed complications included, vitreous loss (21.4%), iridodialysis (7.1%), cornea striae (14.3%), posterior capsule opacity (21.4%), uveitis (42.9%) and raised intraovular pressure (14.3%). Anterior chamber lens implantation for visual rehabilitation of uni-ocular aphakia is safe and effective.

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Enterococcus faecalis is the most common of the Enterococcus genus causing infection, particularly urinary tract infections, worldwide. It is also a common cause of nosocomial infections and resistance to various antibiotics is on the increase worldwide. Thirty-five strains of E. Faecalis isolated from various clinical specimens (blood, wound swabs endocervical swabs but mostly urine) were screened for high-level aminoglycoside resistance. Their susceptibility nine antibiotics (ampicillin, gentamicin, streptomycin, vancomycin, tetracycline cotrimoxazole and chloramphenicol, ciprofloxacin and erthromycin) was also determined. All isolates were susceptible to Ampicillin and Vancomycin with MIC90 of 4microg/ml but resistant to Nalidixic acid with an MIC90>256microg/ml. Four (11%) of the isolates showed high-level resistance to Gentamicin while 11(32%) exhibited high-level resistance streptomycin after 24 hours incubation. It will appear that Ampicillin in combination with gentamicin but not streptomycin, can still be used empirically for the treatment of Enterococcal infections.

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Infants with intussusception in tropical Africa frequently present late. Intestinal resection for gangrene or perforation may warrant a right hemicolectomy. Over a period of 11 year, 15 (45.5%) of 33 infants with intussusception required bowel resection, 10 of which were right hemicolectomies. The age range of those who had right hemicolectomy was 3-9 months (median 6 months) and duration of symptoms 3-8 days (median 6 days). In addition to features of intussusception, seven (78%) infants were dehydrated and one was anaemic. Six (67%) of 9 infants developed procedure related complications postoperatively. Four (44%) had anastomotic dehiscence, associated with abdominal wound dehiscence in 2. In 3 of the patients, the anastomosis leaked again following repeat resection and anastomosis, necessitating relaparotomy and stoma formation. One (11%) patient each had wound infection and prolonged ileus respectively. Six (67%) patients died, including the 4 who had anastomotic dehiscence. The cause of death was overwhelming infection in 4 patients and aspiration of vomitus in two patients. Recommendations are made to minimize morbidity and mortality in these infants.

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Much of the literature is concerned with variation in root canal morphology rather than variation in root morphology. The present communication reports two rare cases of patients with aberrant root morphology in all their mandibular premolars examined. The role of intra-oral preoperative radiographs of diagnostic value is emphasized, without which unexpected complications during endodontic treatment or extraction may occur. Failure of endodontic treatment as a result of the inability to negotiate and instrument one of the canals in the aberrant root is an important difficulty that may be encountered with such variant teeth.

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This paper reports bilateral congenital convex pes valgus frequently termed vertical talus. A successful simple one-stage surgical reconstruction is described to enhance the understanding of the management of this rare complex deformity. Long follow up is emphasized because of a high incidence of recurrence. There has been a one-year follow up so far. Plantigrade and painless feet have been achieved which enables the patient to wear normal shoes.

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A retrospective analysis of complications following female sterilization via minilaparotomy performed in Jos University Teaching Hospital between January 1985 and December 1999 was undertaken to determine the incidence, the type of complications and identify ways of improving the service. 2986 clients had female surgical contraceptions. Major surgical complications occurred in 0.87% of the clients. Minor complications were seen in 4.15% with wound sepsis contributing 3.75% to the rate. The crude failure rate was 0.23%. Re-anastomosis was the reason for the failures not surgical misapplication of devices nor fistulous opening as found elsewhere. There was no death in the series. Clients seeking surgical contraception should be counseled about the minimal major surgical and minor complications that could occur during the procedures. Our center will need to focus on infection prevention in female surgical contraception in order for the services to enjoy continuous acceptance by the clients.

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A case of failed peritoneal dialysis in a 5-year-old male nephrotic who developed acute renal failure following severe P. falciparum malaria infection is presented. Peritoneal dialysis (PD) failure was sequel to undetected severe dehydration which occurred during the diuretic phase of the acute renal failure. Pre-dialysis plasma potassium, bicabonate, urea and creatinine concentrations were 6.0mmol/L, 13mmol/L, 28mmol/L and 900mmol/L respectively, after about 22 hours of PD, the plasma K+, HCO-3 Ur and Cr were 5.7mmol/L, 15mmol/L, 32mmol/L and 1,090mml/L respectively. The peritoneal dialysate Ur concentration (3.5mmol and peritoneal Ur clearance (1.85ml/min/1.73m2) were grossly inadequate. There was also, intradialysis hyperglycaemia (12mmol/L owing to massive absorption of peritoneal dialysate solution which contains high concentration of glucose. Hyperglycaemia was corrected with 0.25 units/kg/dose of soluble insulin intravenously, he had two doses. Owing to similarity of clinical and biochemical features of dehydration and ARF, all efforts must be made to exclude dehydration before embarking on PD in patients with renal failure. Failure to exclude dehydration, led to PD failure in this patient.

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Hepatitis B virus (HBV) infection, a major world health problem, is hyper endemic in South-East Asia and sub-Saharan Africa including Nigeria. Being a major cause of morbidity and mortality, prophylaxis using the highly efficacious hepatitis B vaccine is recommended for those at risk. The prevalence of serological markers of chronic HBV infection was determined in a population of 100 outpatient diabetics and 80 non-diabetic controls at the Medical Outpatient Department of the Lagos University Teaching Hospital Idi-Araba between January and July 1992. Twenty diabetic patients [20%] and 14 controls [17.5%] had serological markers (HbsAg and antiHBc) indicating ongoing chronic HBV infection. The difference between diabetics and non-diabetic controls was not statistically significant (P>.05). None of the HbsAg and antiHBc positive diabetics [45%] and 8 control patients [57%] were HbeAg positive. The presence of serological markers was not related to the duration, type of diabetic treatment and degree of diabetic control. Our findings suggest that diabetics in Lagos appear not to be more predisposed to chronic HBV infection than the rest of the population, and therefore would require no special antiHBV prophylaxis.

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