AIM: The aim of the article is to report our experience with prosthetic reconstruction of ear defects in Nigerians. MATERIALS AND METHODS: A review of all consecutive cases of alloplastic (prosthesis) reconstruction of auricular defects was conducted at the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital. Data collected included age and sex of patients, aetiology of defects, site of defects (left or right), lost tissue (partial or total), material used for the fabrication, and mode of retention of the prosthesis. RESULTS: A total of 33 consecutive patients who had prosthetic reconstruction of auricular defects during the period were included. The male-to-female ratio was 3.7: 1. Six cases (18.2%) were congenital defects and 27 (81.8) cases were acquired defects. Three (50%) of the congenital cases were microtia. Majority (63%) of the acquired cases were due to road traffic crashes. Total loss of the auricle was recorded in 22 (66.7%) patients. Of the patients with partial loss of the auricle, pinna was the major structure lost in 5 patients while pinna +lobe were lost in another 5 patients. Silicone elastomers was the most frequently used material for the fabrication of auricular prostheses (29 patients). The most frequently used retention method was silastic medical grade adhesive. CONCLUSIONS: Prosthetic option is a valuable technique for the reconstruction of ear defect. The primary indication for prosthetic reconstruction of ear defect in the present study is acquired ear deformity; mainly due to road traffic crashes.

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OBJECTIVE: The aim of the present study is to critically review relevant literature regarding the mechanism of blowout fractures of the orbit and provide an answer to the question: Can one theory adequately explain the mechanism of orbital blowout fractures in the light of present day knowledge? MATERIALS AND METHODS: A computerised literature search using MEDLINE was conducted for published articles on orbital blowout fractures. Mesh phrases used in the search were: orbital blowout fractures AND mechanisms; orbital blowout fractures AND theory; orbital wall injury AND mechanisms. Only relevant articles were selected for the review. RESULTS: The physical mechanism of orbital blowout fracture has been a subject of debate for years by maxillofacial surgeons, ophthalmologists, plastic surgeons, otolaryngologists and orbitologists. However, only 3 mechanisms of injury have been proposed namely: "hydraulic" theory, "globe-to-wall" theory and "bone conduction" theory. Most of the theories of orbital blowout fractures have been confirmed through brilliant experiments and hypothetical explanation/analysis of clinical and radiologic findings, and each one appears to fit according to the different type of trauma received. CONCLUSIONS: Based on contemporary evidence, one theory may not adequately explain all types of fractures completely or be responsible exclusively in a given case for the pattern of fracture observed. Blowout fractures of the orbit could therefore be due to a combination of 2 or more mechanisms.

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OBJECTIVE: To retrospectively audit and analyse all the Transfontanelle Neurosonographic scans performed at the Aminu Kano Teaching Hospital (AKTH), between January to September, 2004. METHODS: Information on the gray scale appearance of the ventricles, cerebral and cerebellar parenchyma, extra axial fluid spaces, status of the sulci and gyri and the echogenic internal outline of the bony skull vault was extracted from the records of all the Transfontanelle neurosonographic scans performed at the specialist Ultrasound clinic of the AKTH, between January to September, 2004. RESULTS: Eighteen infants were scanned, and 8 (44.4%) of them were neonates. Meningitis (9 patients) and increasing head size (7 patients) were the commonest clinical indication for referral. Communicating hydrocephalus was the only known complication seen in 4(44.4%) of the post meningitic patients. While in the increasing head size group, congenital malformations such as Aqueductal stenosis and Arachnoid cyst of the quadrigeminal cistern as well as hydrocephalus predominates (4 out of 7 patients). The last 2 patients referred on account of severe birth asphyxia and swollen occiput showed no abnormality and occipital meningocoele respectively. CONCLUSION: This study confirms the earlier notion of the pre-eminence of infection as compared to congenital malformation as the leading cause of infant morbidity in developing nations. It also emphasises the value of Transfontanelle neurosonography as an excellent, non-invasive, inexpensive, rapid and safe imaging modality for the evaluation of the pathologic conditions of infants' brain.

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OBJECTIVES: Aspirin and selenium have been shown in vitro and in vivo to inhibit HIV production through inhibition of the transcription factor, the nuclear factor kappa binding (NF-eB). The aim of this study was to examine the efficacy or otherwise of these drugs in people living with HIV and AIDS (PLWAS) in resource limited countries. PATIENTS AND METHODS: Consenting HAART-naive PLWAS with mean CD4 count of 256.8 +/- 67.6 cells/ul were recruited into the study. Pretherapy blood count, serum biochemistry, chest x-ray, urinary glucose and protein and microscopy and culture of both urine and stool were checked in all cases. Each patient was treated for six months and CD4 counts were repeated at the end of the study. Thirty two patients (23 (72%) females and nine (28%) males), aged 22-52 (median = 36) years were recruited. Twenty-three (72%) were randomised into selenium and aspirin (SAM) and nine (28%) into selenium (SM); multivitamin was added to each arm. RESULTS: Eighteen (56.2%) patients completed the study. Sixteen (88.9%) patients are already on HAART since the termination of the study; one absconded and one died of disease progression. Fourteen (43.8%) of the initial 32 patients dropped out (11 (78.6%) were lost to follow-up, two (14.3%) died and one (7.1%) opted for HAART before completing the study). The post-treatment CD4 count was 293.0 +/-102.2 cells/ml, compared to the pre-therapy mean of 256.8 +/- 67.6 cells/ul, an average rise of 36.2 cells/ul, the difference was not statistically significant (p = 0.059). The post-therapy mean weight was significantly higher than the pretherapy weight, 61.6+/-15.2 kg versus 60.0+/-14.3 kg (p = 0.015). CONCLUSION: The SAM/SM combination regimen improved the quality of life of PLWAS, however, a greater number of patients and a longer period of follow up, are necessary to arrive at a more meaningful conclusion.

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OBJECTIVE: To assess whether parity influences progress of labour between primigravidae and multiparae as recorded on the partgraph. PATIENT AND METHODS: Retrospective analysis of partographs of women who were monitored with partograph prior to delivery. Participants were selected using specified exclusion criteria. RESULTS: Out of the 1,319 deliveries in the year 2004, 445 women had partographic monitoring; 368 medical records were retrieved and analysed. There were 136 (37.0%) primigravidae and 232 (63.0%)multiparae. The two groups were similar in booking status and risk level. Primigravidae had lower rates of spontaneous labour onset (78.7%) and thus higher rates of induction labour (21.3%) than multiparae [p< 0.05; OR.51, 95% Cl (0.28 - 0.93). Primigravidae presented at lower cervical dilatations and had more frequent vaginal examination than multiparae. Most multiparae (78.2%) had delivered within 6 hours of admission compare with primigravidae (53.1%); prolonged labour occurred more frequently in primigravidae than multiparae (6.9% vs 1.8%). These differences were statistically significant (p=0.000). Higher rates of inadequate uterine contractions were noted among primigravidae. Primigravidae more frequently crossed the alert and reached the action lines compared with multiparae; higher rates of augmentation of labour and emergency caesarean section were also recorded among primigravidae. The outcomes for mother and infant were similar in the two groups. CONCLUSION: Primigravidae are at a higher risk of dystocia compared with the multipara. Quality monitoring of the primigravida with the partograph will reduce the morbidity and mortality in both mother and the newborn.

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OBJECTIVES: We sought to investigate the possible effect of chronic administration of vitamin E on haemodynamic responses to sympathetic stimulation and to test the hypothesis that chronic administration of vitamin E increases susceptibility to orthostatic intolerance. METHODS : Sympathetic stimulation was assessed by responses in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), forearm blood flow (FBF; venous occlusion plethysmography) and forearm vascular resistance (FVR) evoked by postural stress (600 head-up tilt; HUT) or cold pressor test (CPT) in 30 healthy young men before and after 4 weeks of vitamin E administration. CPT was induced by immersing a hand in water at 40 degrees C for 2 minutes. RESULTS: Administration of vitamin E reduced SBP (p<0.001), DBP (p<0.001), MAP (p<0.001), HR (p<0.001) and FVR (p<0.05) but increased FBF (p<0.01). Before vitamin E administration HUT increased HR (p<0.001). Conversely, HUT led to a decrease in HR (p<0.05) after vitamin E administration. The decreases in SBP (p<0.05) and FBF (p<0.05) with concomitant increases in DBP (p<0.001), MAP (p<0.001) and FVR (p<0.001) induced by HUT before vitamin E administration, were similar to those induced by HUT after vitamin E administration. The increases in SBP (p<0.001), DBP (p<0.001), MAP (p<0.001), HR (p<0.05), FVR (p<0.001) and a decrease in FBF (p<0.001) induced by CPT before vitamin E administration, were attenuated following vitamin E administration in these subjects. CONCLUSION: These results demonstrate that chronic administration of vitamin E significantly reversed HUT-induced tachycardia and prevented CPT-induced vascular and pressor responses. These findings suggest that vitamin E may exert cardioprotective effect presumably through enhanced cardiac vagal tone that may not be associated with poor orthostatic tolerance in young men.

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OBJECTIVE: This is a 14-year retrospective histopathologic study of 720 lymph node biopsies. The aim is to document the causes of lymphadenopathy, the age and sex distribution in Lagos. MATERIALS AND METHODS: The materials consisted of slides and paraffin embedded blocks of all lymph node biopsy specimens received from within and outside Lagos University Teaching Hospital, Lagos. RESULTS: A total of 720 biopsies from 276 males and 444 females were analysed. Chronic non specific lymphadenitis 245 (34%), tuberculosis 125 (17.4%), metastatic lymph node lesions 242 (33.6%), and lymphomas 102(14.2%) were the common causes of lymph node enlargement. The commonest lymph node group affected was the cervical 283 (39.3%). CONCLUSION: Malignancy (47.8%) is the most common cause of superficial lymphadenopathy in Lagos metropolis. The age, sex and site prevalence agree with reports from other parts of Nigeria and Africa with minimal variations.

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OBJECTIVE: The prognostic value of the NIHSS score has not been evaluated in Africans. The study objective was to compare the NIHSS score at presentation to mortality and prognosis in survivors. METHODS: We studied 87 patients with acute ischaemic stroke. Their presenting NIHSS score, Clinical features including complications were recorded on admission. Mortality and outcome within 90 days were evaluated using Glasgow Outcome scale. RESULTS: Patients with NIHSS score of 20 and above had mortality of 56.5%, all survivors had severe disability: NIHSS score between 15-19, mortality was 30% and of survivors, 42.8% had severe disability, 33.7% moderate disability and 14.2% recovered completely. With NIHSS score between 6-14, mortality was 24.9% and of survivors, 13.3% had severe disability, 36.6% moderate disability and 50% had good recovery. With NIHSS score of 5 or less there were no deaths and of survivors, 30% had moderate disability and 70% good recovery. It was however observed that if initial NIHSS score remained static or worsened, prognosis was worse. Among such patients those with initial NIHSS score of 20 and above all died, compared with those with NIHSS score of less than 20 who had mortality of 70% CONCLUSION: The 30th day mortality index was the best predictor of mortality. High mortality were observed in patients with NIHSS scores 20 and above, presence of neurological complications and static baseline scores. After 90 days, good outcome was observed in patients with the least scores and severe disability in high score survivors.

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OBJECTIVE: This case report seeks to create awareness of the aetiology of rickets of prematurity among very low birth weight infants in Nigeria METHODS AND RESULT: This is a case report of an 800 gramme premature male neonate delivered by caesarean section at 28 weeks gestation following severe maternal pre-eclampsia. The infant was hospitalised for sixty days and fed exclusively on his mother's breast milk for seven months. He had two episodes of sepsis and was transfused twice while on admission. He was on Abidec drops, which contained 400 IU/0.6 ml of vitamin D from the age of two weeks. He defaulted from the follow up clinic at postnatal age of 16 weeks only to reappear at 30 weeks postnatal age with overt clinical, biochemical and radiologic signs of rickets. He responded well to calcium and phosphate supplementation. CONCLUSION: This case highlights the role of mineral deficiency in the aetiology of rickets of prematurity in very low birth weight infants fed with their mothers' breast milk.

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AIMS AND OBJECTIVES: To evaluate the effect of HIV-1 infection and its progression on lipid profiles, acute-phase proteins and to determine which of the parameters may serve as an early indicator of the progression of HIV infection. MATERIALS AND METHODS: A cross-sectional study was conducted on sixty-two HIV-1 infected subjects attending HIV clinic, the patients consisted of 29 males and 33 females aged between 20-60 years (mean age 31+/- 7 years) who were screened for HIV-1 by ELISA test. Absolute CD4+ T lymphocyte was counted and HIV infected individuals were classified according to the Centre for Disease Control and Prevention (CDC) Criteria; CD4+ counts e"500/mm3 (asymptomatic), CD4+ counts 200-499/mm3 (symptomatic) and CD4+ counts d"199/mm3 (symptomatic) with full blown AIDS. Serum concentrations of total protein, albumin, gamma globulin, acute-phase protein, and lipid profile were determined. RESULTS: There was significantly increased gamma globulin fraction of the serum protein in HIV patients with CD4+ counts of e"500/mm3, 200-499/mm3 and d"199/mm3 when compared with the controls. Serum triglyceride was significantly increased in HIV patients with CD4+ counts of d"199/mm3 only, whereas a significantly decreased serum HDL-cholesterol in HIV patients with CD4+ counts of 200-499/mm3 and d"199/mm3 was found when compared with the controls. Haptoglobin, C-reactive protein and a1-acid glycoprotein were significantly increased in HIV patients with CD4+ counts of 200-499/mm3 and d"199/mm3 when compared with the controls. However, albumin was significantly reduced in HIV patients with CD4+ counts of d"199/mm3 when compared with the controls. There was direct correlation between HDL-cholesterol and the CD4+ counts, on the other hand, an inverse correlation between C-reactive protein, haptoglobin and a1-acid glycoprotein against CD4+ counts was found. CONCLUSION: A decreased HDL-cholesterol had direct correlation with the CD4+ counts in all the stages of HIV infection; however, increased haptoglobin and C-reactive protein had inverse correlation with the CD4+ counts in all the stages of HIV infection. Therefore HDL-cholesterol, C-reactive protein and haptoglobin may serve as indicators of disease progression in HIV infection.

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OBJECTIVE: The study reviewed and analysed the causes and pattern of death among patients admitted to the Federal Medical Centre, Owo in the year 2004. PATIENTS AND METHODS: The case note records of all patients that died on admission in the hospital for the year 2004 were reviewed. A total of 104 cases out of the 114 patients that died were reviewed. Total admission was 1819 for the year. RESULTS: Annual death rate was 6.3%. Overall, infectious causes of death was the most common (22.1%) ; this was followed by deaths from pregnancy and neonatal preterm related causes(18.3%) while deaths from neurological disorders (stroke, meningitis, and meningo-encephalitis among others) (17.3%); gastro-intestinal disorders(11.6%), respiratory disorders (10.6%) endocrine disorders (7.7%) and others followed in that order. In the medical wards cerebrovascular disease was the leading cause of death; in Obstetrics and Gynaecology, prolonged obstructed labour was the leading cause of death while Paediatrics and Surgery departments had preterm births and head injuries and multiple fractures as the leading causes of death respectively. CONCLUSIONS: Periodic review of hospital deaths could be important in knowing the changing pattern of mortality in our environment. In this study, improvement in the living condition of the citizens, use of potent antibiotics in treating infections and increased patronage of immunisation facilities as ways of control of infections is advocated.

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Congenital diaphragmatic hernias occur through embryologic defects in the diaphragm. We present 2 cases of congenital diaphragmatic hernia, the first case was a late presentation in an 11 month old child, and the second case was an early typical presentation in a day old child, both diagnoses were made on chest radiographs. The paper is focused on the key role of the radiologist in a resource poor environment to make early diagnosis of this fatal and rare condition. Early diagnosis of this defect is essential. This will allow timely intervention and appropriate management, therefore, reducing the mortality associated with the condition.

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BACKGROUND: To achieve sustainable reduction in malaria burden in Africa, cultural practices that foster increased malaria burden must be addressed. In Edo state Nigeria, scarification/tattooing on the left hypochondrium presumably over an enlarged spleen arising mainly from malaria is widely practiced. This practice is deleterious, diversionary and causes complications. AIMS AND OBJECTIVES: This was a cross-sectional and descriptive study to evaluate the beliefs and practice, regarding abdominal wall scarification in children and within the context of malaria control; It was carried out among experienced women in child care selected from Egor Local Government Area of Edo State, Nigeria. METHODS: Information relating to beliefs, knowledge and their practices including possible socio-cultural/economic determinants were obtained with use of questionnaire. RESULTS: Of the 400 questionnaires administered 394 were responded to. The modal age bracket was 26 - 30 years (Range, 18 - 56 years) Respondents were mainly Binis Esan and Ibos amongst others. About 27.0% of respondents considered the spleen a "bag of worms". Other views included "collection of bad blood" 27.2% and as a sickness of its own, 14.7%. Named causes of splenomegaly were fever, 59.6% and evil spirit, 15.5%. Over 45.0% of respondents would consult the herbalists for splenomegaly. Less educated (X2 = 40.0, p<0.005), women over 40 years of age (X2 = 13.5, p< 0.05) and Esan/Bini ethnic groups (X2 = 15.6, p <0.05) are more prone to the practice. Reasons for widespread use included perceived effectiveness, low cost and accessibility. Information on scarification was obtained mainly from family members, 49.5%, neighbours, 25.1%; and friends/colleagues, 16.7% CONCLUSION/RECOMMENDATIONS: Practice of scarification is deep rooted and widespread in the study location. It has potentials to negate efforts involved in malaria control. Education including public enlightenment campaign should effectively check the practice.

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OBJECTIVE: To highlight the importance of considering abdominal Lymphoma as a differential diagnosis in the management of obstructive jaundice. PATIENT: A 51 year old female who presented with abdominal swelling associated with features of obstructive jaundice. Significant findings included jaundice on examination, with abdominal ascites. Laparotomy revealed three litres of icteric fluid. There was a huge left ovarian tumour measuring 14 cm x 12 cm. Massive peritoneal seedling involved the whole abdomen and pelvis was noted. Following surgery allowing for adequate wound healing, the patient was placed on appropriate chemotherapy. INVESTIGATION/DIAGNOSIS: Histology of excision biopsy revealed high grade Non-Hodgkins's Lymphoma. Screening for human deficiency virus (HIV) was negative. However the erythrocyte sedimentation rate (ESR) was raised at 92 mm Westergren in the first hour. The liver function tests were deranged with total bilirubin of 274 micromol/l and conjugated bilirubin of 204 micromol. serum Ast and Alt were also significantly raised. Total proteins, urea and electrolytes remained essentially within normal limits. The patient was placed on CHOP combination therapy. She attained remission after four cycles of chemotherapy and was discharged home. CONCLUSION: Abdominal Non-Hodgkin's Lymphoma should be a strong consideration in the management of obstructive jaundice.

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Intracystic papillary non invasive breast carcinoma is an extremely rare form of intraductal carcinoma constituting 5% of male breast cancer. The latter accounts for only 1% of all breast cancers. Until now, no case has been documented in an African male. This tumour was found in an 86 year-old male. It appeared benign on physical examination. Fine needle aspiration cytology was inaccurate. However, excisional biopsy in the form of total mastectomy with axillary clearance served to diagnose as well as treat the disease. This may be the first case of intracystic papillary carcinoma of the breast in the Nigerian male.

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