Objective: The purpose of this study was to compare the stool antigen (SAT) and immunoglobulin G (IgG) serology tests for helicobacter pylori in dyspeptic patients in Nigeria, and determine their usefulness. Method: Forty six patients with dyspepsia and age and sex-matched healthy controls had their blood and stool collected and screened for H. pylori infection using the enzyme linked immunosorbent assay (ELISA) IgG serology and SAT respectively. Prevalence of H. pylori was 67.4% and 78.3%, among dyspeptics and controls respectively ((p=0.48) with the SAT while the corresponding values for IgG serology were 67.4% and91.3%, p=0.005). Result: Patients aged ≥ 50 years (8) were more positive to SAT (80%), compared with controls(13) which recorded more positivity in the age range 30-39 years (92.9%). The male gender had more positive SAT in patients (n=15, 75%) but the SAT was more positive among the female controls 22(84.6%). Controls in the age range<30 years were more positive to H. pylori IgG while the patients were more positive at = 30yrs 10(100%). Conclusion: It is concluded that SAT and IgG serology for H. pylori are both useful in diagnosis of the infection, and are fairly comparable in their ability o detect infection, even in area of high endemicity.

Objectives: To determine the degree of intraocular pressure (IOP) rise following retrobulbar anaesthetic injection as well as the optimal time required for the return of the IOP to the pre-injection level following ocular massage. Materials and Methods: Using the Perkins hand-held tonometer, the IOP of consecutive adult patients were measured in the operating room before local anaesthetic (3ml of 2% xylocaine with or without adrenaline) injection; immediately after injection and every minute following ocular massage for the next5minutes. Results: Twenty-three eyes of 17 patients, aged 23-71 years, were studied. The mean (±SD) baseline (pre-injection) IOP was 16.6(±6.8) mmHg. Immediately after the injection the IOProseby11.8-80% with a mean of 37.3±16.8% (95%CI: 30.4-44.2). By 3 minutes the IOP had returned to the pre-injection level. After 3 minutes the IOP had become lower than the pre-injection level (p<0.05) Conclusions: IOP rise following retrobulbar injection of 3 ml of local anesthetic varies from 11.8-80%. Digital ocular massage lowers the IOP to pre-injection levelin60.2% in3minutes; in 5 minutes it lowers the IOP to pre-injection level in all eyes and to below pre-injection level 86%.

Introduction: The prevalence of overweight is rising even in countries with significant rates of under-nutrition. This is exacerbated by westernization of lifestyles and the image of prosperity associated with overweight. Children are not spared and the health consequences may become apparent in the near future. This study assessed the prevalence of overweight among adolescents in an urban city in a developing country. Methodology: This cross-sectional study conducted from September to December 2005 involved 300 adolescents selected by cluster sampling in Benin-city, Nigeria. Overweight and risk of overweight were defined as Body mass index (BMI)-for-age≥ 95 ^th percentile and BMI-for-age 85 ^th to < 95 ^th percentile respectively. Results: Of the participants, 5.7% were overweight while 52.7% were at risk of overweight. Risk factors of overweight identified were consumption of snacks (64.3%), soft drinks (85.7%) and physical inactivity (69.7%). Being overweight was significantly associated with consumption of snacks, soft drinks, physical inactivity and positive family history of obesity, (p<0.05). Conclusion: The high prevalence of risk factors for overweight suggests that the already high prevalence of overweight will increase in the near future. Preventive measures are required to forestall this increase.

Background: Congenital malaria has been increasingly documented in endemic regions. It is important to recognize those clinical features that are due to congenital malaria, which if undetected, might worsen the morbidity of the newborn. The aim of this study was to document the clinical presentation of neonates with congenital malaria born at the Lagos University Teaching Hospital and followed up for 28 days. Methods: A total of 100 consecutive mothers and their newborns were recruited between August and October 2002 (during the rainy season) from the labour ward and followed up from birth to 28 days of age. Blood films from the placentae and babies were stained with Giemsa stain within 24 hours of collection. All parasitaemic babies that became symptomatic were screened for sepsis using acute phase responses and cultures. All data were entered into a prepared proforma. Symptoms were attributed to malaria when sepsis screening was negative. Results: Congenital malaria was documented in 13.6% of babies at delivery. Jaundice, irritability and poor feeding were most common symptoms associated with congenital malaria. Irritability and poor feeding had positive predictive values (PPV) of 100% on Day14. Conclusion: Babies who present with poor feeding and irritability on Day 14 of life should be screened for malaria in addition to the routine investigations for neonatal sepsis.

Objective: To evaluate the practicability of autologous blood donation and transfusion in the practice of obstetrics and gynaecology in our environment. Method: A prospective study of 1221 obstetric and gynaecological patients to which autologous blood donation and transfusion was carried out at the University of Maiduguri Teaching Hospital, Maiduguri over an 8 year period (January,1998toDecember, 2005). Results: During the study period, there were 15,267 blood transfusions in the UMTH out of which 5,711 were for Obstetric and Gynaecological patients given a transfusion rate of 47.7% in the unit. Out of the 5711 transfusion in the obstetrics and gynaecology, 1221 were by autologous means; a rate of 21.4%. Of the 3010 transfusion in obstetrics 625 (20.7%) were of autologous blood and of the 2711 transfusion in gynaecological patients 596 (22.1%) were of autologous blood. Preoperative blood donation was done in 598 (95.8%) of the obstetrics autologous blood donation out of which, 40 (6.4%) pre-deposited 2 units. Five hundred and sixty (94.1%) gynaecological patients had preoperative blood donation outofwhich,46(7.7%) predeposited2units. Induction of labour constitutes the major indication 337 (53.9%) for the autologous blood donation in obstetric while the major indication in gynaecology patients was myomectomy (25.7%).The main complications encountered were dizziness, and fainting attack that necessitated re-infusion in one patient. Conclusion: Autologous blood donation and transfusion procedure is feasible in the setting of obstetrics and gynaecology and it does not require high technical procedure.

Objective: To determine the factors affecting utilization of ITN by pregnant women in Etsako West LGA, Edo State. Methodology: A descriptive cross-sectional study design was employed. Using a systematic sampling method, a total of 385 respondents were selected from all ANC facilities in the LGA following a verbally obtained consent. Tool for data collection was a semi-structured, researcher administered questionnaire. Result: The respondents' knowledge of cause of malaria was good, as 269 (69%) had good knowledge but only 9 (2.3%) knew its effects on the foetus. Meanwhile, ownership of ITN and its use were very low, 36(9.3%) and 31 (8.0) respectively. The main factor affecting the use of the commodity in the LGA was unavailability of ITNs. Other factors included belief of the women on the effectiveness of the commodity, level of education, marital status and family sizes of respondents. Conclusion: Use of Insecticide treated bed net has been hampered by unavailability of the commodity. It is therefore recommended that efforts should be made to make the commodity available to reduce morbidity and mortality among this vulnerable group.

Objective: The contribution of Eclampsia to maternal mortality in Nigeria is well documented. In Irrua it accounts for over 25% of maternal deaths. Addressing Eclampsia is therefore apriority programme of the Irrua Safe motherhood Initiative. Aim: The aim of this study is to determine the incidence of eclampsia, its clinical correlates and outcome. Finally strategies will formulate programme implementation. Materials and Methods: This is a retrospective study of cases of eclampsia in Irrua Specialist Teaching Hospital, Edo state; over a five-year period. Information was retrieved using a structured proforma. Statistical analysis was done using the excel statistical package and the Epi info 2002 statistical software. Results: Seventy eight (78) were admitted in the 5 year study. This accounted for 2.52% of total labour ward admission. However only 74 case notes were available for analysis. 70/74 of the patients were unbooked emergencies. Among the unbooked patients, 38/70 (54.29%) of the unbooked had not received any antenatal care whatsoever. The incidence was disproportionately higher in younger women and teenagers as well as in primigravida. 55/74 (74.32%) had preceding headache while 21.62% had a prior history of blurred vision, 14.86% had epigastric pain.16.22% had restlessness while 10.81% had nausea and vomiting each. The perinatal mortality rate was 28.38% while the maternal mortality ratio was 22.97%. Maternal mortality was associated with poor urinary output (0.0003), history of native medication (0.0199), number of fits (0.00209). Platelet count below 50,000/ml, highest systolic blood pressure above 200mmhg (0.000018) and pulmonary oedema (0.000558). Conclusion: Addressing Eclampsia in Irrua will include community campaigns, capacity building, retraining of staffs within the hospital and improved facilities for the management of cases.

Background: Fibroids remain the commonest pelvic tumour seen in women with myomectomy being the major form of treatment in our environment. Techniques to minimize blood loss will reduce patient morbidity and the need for blood transfusions. One such technique is the use of a tourniquet during myomectomy operation. This study examines the effectiveness and safety this tourniquet technique. Method: A comparative analysis of the blood loss, transfusion rate and the morbidities associated with the use and non-use of a tourniquet during myomectomy operation at Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria was undertaken. The Foley's urethral catheter was adapted as a uterine tourniquet and applied as low as possible at the base of the uterus before enucleating the fibroid masses. Result: The patients who had their myomectomy performed with application of a tourniquet [tourniquet group] and those without [no-tourniquet group] were evenly matched for age, parity and presenting symptoms. The overall mean age of patients was 35.7 + 6.1 years and parity was 0.40 + 1.25. The main presenting symptoms of the patients were lower abdominal mass 65.6%, menorrhagia 38.7%, infertility 33.3%, abdominal pain 19.4%anddysmenorrhoea14.0%.There was a statistically significant difference [P< 0.001] in mean blood loss for the no-tourniquet group[756.4 + 285.7] and the tourniquet group [515.7 + 292.8] as well as the mean blood transfusion rate in no-tourniquet group[1.0 units + 1.14] and the tourniquet group[0.24 units + 0.51]. However there was no significant difference between the two groups with respect to complication profile. Conclusion: The Foley's catheter form of tourniquet is cheap, safe, effectively reduces blood loss during myomectomy and significantly reduces transfusion rate while not adding to the complications due to the operation.

Background: Hypertension remains the commonest non-communicable disease in Nigeria and a leading cause of cardiovascular morbidity and mortality. Knowledge and practice among hypertensive patients were therefore assessed as a prelude towards attaining better blood pressure control. Materials and Method: 224 consecutive hypertensive patients were prospectively studied using a pre-tested questionnaire. Results: Majority of the hypertensive patients attending University of Ilorin Teaching Hospital were either traders or business men/women (44.5%). Only 35.8% had their blood pressure well controlled and about 61% were diagnosed for the first time to be hypertensive in the teaching hospital. 34% of the patients commuted a distance of more than 5km to the hospital to receive antihypertensive care. 52% and 25% of the patients checked their blood pressure monthly and three-monthly respectively. One patient volunteered history of smoking. 48% and 51.8% knew that smoking increases the propensity to develop complications and that exercise is beneficial for the control of blood pressure respectively. Knowledge of the possible complications of hypertension was very poor as 58.9% of the patients scored less than average. Only 41.1% and 1.8% of the patients were aware that excessive salt and fat intake could adversely affect the control of hypertension respectively. Conclusion: Blood pressure control is still unacceptably poor among hypertensive Nigerians. This may not be unconnected with the poor knowledge of hypertension and adverse practices by the patients.

Objective: The use of Fine Needle Aspiration Cytology (FNAC) in the investigation of goitres was introduced into our practice more than a decade ago. This is a review of its diagnostic accuracy for thyroid carcinoma seven years after the first evaluation and following the establishment of the 'FNAC Clinic'. Method: This is a retrospective study of patients who had FNAC of goitres and the histopathology of their thyroidectomy specimens between 1995 and 2004.Theaccuracyofthe cytology reports were evaluated against the histology reports. The turnaround time of the patients for surgery was also determined. Results: There were 130 females and 21 males with an age range of 7-86 years. The diagnostic accuracy of the procedure for carcinoma was 89% with a sensitivity of 35%, specificity of 97%, positive predictive value of 64%, and a negative predictive value of 91%. The average turnaround time for surgery was 178.7 ΁ 248.7 days with a range of five days to three and a half years. Conclusion: The diagnostic accuracy of FNAC of goitre for carcinoma improved in the period under review. However, the long surgery turnaround time may reduce the usefulness of the procedure. The accuracy may be improved further by a protocol of ultrasound guidance, capillary collection with no-aspiration technique, on-site review of slides with a repeat of FNA as necessary.

Objective: To evaluate the challenges and outcome of management of large abdominal wall hernias in a resource limited environment and highlight the options available to surgeons in similar conditions. Design: A review of prospectively collected data on large abdominal wall hernias managed between 2003 and 2009. Setting: University of Nigeria Teaching Hospital, Enugu, Nigeria and surrounding hospitals Subjects: Patients with hernias more than 4cm in their largest diameter, patients with closely sited multiple hernias or failed previous repairs and in whom the surgeon considers direct repair inappropriate. Outcome measures: Demographics of patients with large hernias, methods of hernia repair, recurrences, early and late complications following the repair. Results: There were 41 patients, comprising 28 females and 13 males with ages 14 - 73 years. Most (53.7%) were incisional hernias. Gynecological surgeries (66.7%) were the most common initiating surgeries. Fifteen of the patients (36.6%) have had failed previous repairs, 41.5% were obese, five patients presented with intestinal obstruction. Thirty nine of the hernias were repaired with prolene mesh, one with composite mesh and one by danning technique. Most of the patients had extra peritoneal mesh placement. Three patients needed ventilator support. After a mean follow up of 18.6 months, there was a single failed repair. Two post op deaths were related to respiratory distress. There were 12 wound infection and 8 superficial wound dehiscence, all of which except one resolved with dressing. One reoperation was done following mesh infection and extrusion. Conclusion: Large abdominal wall hernia repair in resource limited environments present several challenges with wound infection and respiratory distress being the most notable. Surgeons who embark on it in these environments must be prepared to secure the proper tissue replacement materials and have adequate ventilation support.

Background: Immunization coverage in most areas in Nigeria has remained low with continued high morbidity and mortality from vaccine preventable diseases. Objectives: To identify the reasons and beliefs about immunization among mothers whose children have not received adequate immunization or not at all. Subjects and methods: The study was a descriptive cross sectional survey that involved mothers trading in a large market in Ibadan who had children between the ages of 12 and 23 months. Data were collected by means of a semi-structured questionnaire. Mothers who did not immunize or failed to completely immunize their children were selected for analysis. Results: A total of 248 mothers were interviewed, their mean age was 27.3 5.5 years (range 16 42yrs). The commonest reasons for incomplete immunization included: non availability of vaccines (26.2%), not being aware of need for additional doses (16.5%) and inconvenient time/venue (13.7%). Logistic regression analysis showed that Mothers with no formal education were about six times more likely than those with secondary education and higher to give reasons related to lack of motivation (95% CI OR = 1.88 17.93). Analysis of the mothers' beliefs on immunization were as follows; 186(75.0%) believed it was beneficial, 161(64.9%) believed that immunization will save the life of the child and 129(52.0%) believed that taking the child to the clinic for immunization wasted a lot of time. Conclusion: Most mothers in this study agreed that immunization is beneficial. It is therefore recommended that routine immunization be strengthened, vaccines made readily available and mothers educated on the immunization schedule.

Objectives: To analyse the pattern of findings in sonographic examination of infant brains. Setting: Radiology Department of a University Teaching Hospital. Materials and Methods: The ultrasound request cards, reports and case notes of 114 consecutive term infants who underwent transfontanelle ultrasonography over a four-year period (between 1st May 2000 and 31stApril 2004) were retrospectively analysed. The transfontanelle ultrasonographies were done using a two dimensional Sonoace 1500 (Medison Inc, South Korea 1995) ultrasound scanner fitted with 6.5 megahertz (MHz) curvilinear small head probe. The scans were done in both coronal and sagittal sections applying the standard techniques. Result: A total of 114 infants were seen in the study period with male to female ratio of 1:1. Sixty eight patients (59.65%) presented within the first 2 months of age. Hydrocephalus 34 (29.04%), seizure disorders 16 (14.04%) and suspected intracranial bleeding 19 (16.67%) constituted over half of the presenting complaints. The result showed that 54 patients (47.37%) had normal findings, 43 (37.72%) had hydrocephalus of which in 25 (21.93%) it was communicating while in 18 (15.79%) it was non-communicating 6 (5.26%) had cephalohaematoma, 5 (4.39%) had encephalcoele, 4 (3.51%) had periventricular leukomalacia, and 2 (1.75%) had subgaleal cyst. Conclusion: Transfontanelle ultrasonography is a useful technique for diagnosis of lesions within the infant brain. Hydrocephalus is the most frequent reason for request of transfontanelle ultrasound scan and also the most frequent abnormal finding.

Objective: Stress levels of residency are under-reported in Nigeria despite the importance of well-being during residency training. We investigated the level of perceived stress, intimidation/harassment, mental health and well being among resident doctors. Methods: This was a cross sectional questionnaire survey of all residents in training in a Nigerian teaching hospital located in south western part of Nigeria. Results: The response rate was 80.6% (58 out of 72). Forty three (74.1%) of the respondents were males. The mean age was 35.7 ± 2.8years (range = 31-43 years). The mean number of working hours was 88.7hours/week. Fifty percent of residents reported their life was stressful. There were gender differences in conditions like work situation, residency programme, employment status, personal and family safety, caring for children and discrimination in favour of men. Some residents resorted to the use of alcohol (5.2%), cigarette (1.7%), drugs and medications (8.6%) to handle stress. A greater majority of the residents (61.4%) would pursue another career if they had to do it all over, while 34.5% would consider changing to another teaching hospital for their residency. Many residents reported experiencing intimidation and harassment. Eighteen (31%) of the residents admitted to have had emotional or mental health problems during the residency program. About 29% will require further screening for depression, 21.6% for panic disorder, 15.8% for generalized anxiety, 9.3% for social phobia and 8.8% for agoraphobia. The study design however did not allow prediction of proportion of individuals who had mental challenges, nor allow comparison of such rates to the normal population in the country. Conclusion: Many residents experience significant stressors and intimidation/harassment, some of which differ among gender. This study can serve as a pilot for future research, resource application and advocacy for overall improvements of the well-being of residents in training.

Introduction: The latest versions of spiral CT scanners have provided the radiologist with unparalleled capabilities for vascular imaging. Computed Tomographic Angiography (CTA) has the potential of revolutionizing vascular imaging and with evolving improvements may replace conventional angiography in the near future. Objective: To report our initial experience with CTA in Nigeria; highlighting its usefulness as a non invasive modality and its clinical applications in diagnosis of vascular abnormalities of various parts of the body. Materials and Methods: We reviewed 62 patients who had CTA between December 2003 and September 2005. . The studies were performed using a spiral technique with GE CT/e single-slice scanner (General Electric Medical Systems) having a gantry rotation period of one second. Details of techniques of data acquisition, methods of 3-D reconstruction and clinical applications are discussed. Results: Vascular abnormalities were demonstrated in 26 (42%) patients including 5 cranial arteriovenous malformations (AVMs), 3 intracranial aneurysms, 1 spinal AVM, 3 aortic aneurysms, 5 carotid artery stenosis, and 2 traumatic peripheral aneurysms. Conclusion: Correlations between CTA and surgical findings were good. CT angiography has enhanced our practice of vascular radiology in Ibadan as it has done in the west and other parts of the world.

Objective: To evaluate the contraceptive choices and usage of women in rural Aba, Southeastern Nigeria, and identify factors influencing their choice and usage of modern contraceptive methods. Methods The records of new and old acceptors of family planning methods between 1 November 2005 and 31 October 2007 at the reproductive health clinic of a primary health care center in Osisioma Ngwa local government area in the suburb of Aba, were reviewed and analyzed. Qualitative data was collected by in-depth interviews (IDIs) of 88 out of 188 clients whose records were analyzed. Results: Majority of the clients (71.8%) accepted injectable hormonal contraceptives followed by the intrauterine contraceptive devices (IUDs) (14.4%). Sub-dermal contraceptive implants were accepted by 6.9% of the women and female sterilization by 3.2%.The oral contraceptive pills and the male condom were the least accepted by the clients. Only 2.1% of the contraceptive acceptors were adolescents. The modal age of the acceptors was 30 years and the average age 33.4 years while the age range was 18-51 years. The average parity was 4.7 while the modal parity was 5. The indication for contraception was child spacing in 30% of the clients and permanent limitation of the family size in 70% of the clients. Attitude of the women to the various methods of contraception was an important factor influencing contraceptive choices of the women interviewed. Conclusion: The study has shown that the most commonly used contraceptive method in rural Southeastern Nigeria is the injectable hormonal contraceptives. Strategies to increase contraceptive use in rural Nigeria must include improving delivery of correct and adequate information about the available contraceptive methods.

Objective: To assess knowledge about the partograph and its utilization among maternity care providers in primary health care in southwestern Nigeria. Method: Two hundred and seventy-five maternity care providers comprising of 64 CHEWS (23.3%), 74 Auxiliary midwives (26.9%), 123 Nurses/midwives (44.7%) and 14 medical doctors (5.1%) were interviewed in primary health centres and private hospitals in three states in southwestern Nigeria using a multi-stage sampling strategy. Knowledge about the partograph and assessment of labour were assessed with an interviewer-administered questionnaire. Results: About a quarter of respondents, 75 (27.3%) had received prior training on the partograph. Only 25 (9.1%) reported that the partograpgh was available in their labour wards. Knowledge about the partograph was poor; only 18 (16.0%) of all respondents correctly mentioned at least one component part of the partograph, 21 (7.6%) correctly explained function of the alert line and 30 (10.9%) correctly explained function of the action line. Prior training significantly influenced knowledge about the partograph (γ² = 49.2; p < 0.05). Knowledge about assessment of labour was also poor: less than 50% of all respondents knew the normal duration of labour and just about 50% understood assessment for progress of labour. Conclusion: The partograpgh is not utilized for labour management in Nigeria. Knowledge about partograph and assessment during labour is grossly deficient. Findings suggest poor quality intrapartum care. Effective interventions to improve labour supervision skills and partograph utilization are urgently required.

Objective: To evaluate some epidemiologic and aetiologic factors for male infertility in our patients. Method: All male patients who presented with infertility in urology clinic of the department of surgery between 1991 and 2005 were retrospectively reviewed. Epidemiologic and aetiological factors of male infertility were studied. Result: There were 537 patients; age ranged 18 to 56 years with a mean of 34 ± 9.0 SD years. Primary infertility was seen in 515 (96%) patients. About 70% were infertile for 2 to 6 years. Primary testicular insufficiency was seen in 260 patients (48.7%) mainly resulting from genitourinary tract infection. Azoospermia resulting from testicular pathology was seen in 18 (3.4%) and obstruction to the vas or epididymis was seen 75 (14.0%) patients. Two hundred and fourteen (45%) patients had oligospermia resulting from testicular insufficiency while 61 (11.4%) had oligospermia due obstruction. Conclusion: Infertility resulted mainly from preventable causes. This can be prevented by prompt and adequate treatment of genitourinary infection, testicular maldescent and testicular torsion.

Objective: Intra-partum care has a significant influence on birth outcomes. Gap however exists between evidence and practice. This study documented pattern of intra-partum monitoring among birth attendants in public secondary healthcare facilities and related findings to quality of care provided. Method: Intra-partum monitoring records of vaginal examination, fetal heart and blood pressure were reviewed. Research assistants extracted information and documented same in appropriate section of Safe Motherhood Needs Assessment forms. Monitoring records were categorized into optimal and sub-optimal care. Proportions were calculated for parturients who received either optimal or sub-optimal care. Chi-square test of statistics was used to explore differences. Level of significance was p < 0.05. Result: A review of 349 records of paturients was carried out. Their mean age was 23.4 ± 3.3 years. Pregnancy outcome was a live-birth in 329 (97.3%). Optimal care of vaginal examination, fetal heart monitoring and blood pressure measurement was provided in 243 (71.9%), 73 (21.6%) and 52 (15.4%) parturients respectively and diminished significantly as labour progressed. Conclusion: Intra-partum care provided by birth attendants was generally sub-optimal and use of the monitoring records to influence birth outcome is doubtful. Improvement in record keeping practices and skills in intra-partum monitoring for decision making, are suggested.

Background: Breast cancer, the commonest female malignancy in Nigeria presents late, with bulky loco­regional masses and predominantly in a pre and peri-menopausal setting. Treatment when feasible has been with mutilative surgery with a poor patient acceptance rate. Chemotherapy which is widely used in adjuvant and metastatic settings has recently been indicated in the neo-adjuvant setting. Methods: Locally-advanced female breast cancer patients [AJCC Stages IIIA, IIIB, IIIC], seen in the breast clinic from July, 2006 to March 2007 were recruited into the study after informed consent. Patients received doxorubicin, 5-fluoro-uracil and cyclophsphamide by intravenous bolus or infusional injection on a three weekly regimen as day cases. The dominant lesion was assessed by calipers at each visit. Therapeutic clinical responses were assessed as none; partial, complete. Results: During the period 32 women (33 breast cancers) were seen and recruited. The numbers steadily declined over time and only 28 completed the treatment modality. Mean pre-chemotherapy tumour size was 13.5cm which declined to 7 cm at the 5 ^th . One patient (3.6%) exhibited complete clinical response, 25 (89%), partial response and 2 had no response. No serious toxicities were noted. Conclusion: Neo-adjuvant chemotherapy using anthracycline based regimens is efficacious and safe in reducing tumour bulk in locally advanced breast cancers. The use should be encouraged to make bulky tumours operable.

Objective: Hereditary Multiple Exostoses (HME) is a genetically transmitted bone dysplasia that is inherited in an autosomal dominant manner. It usually presents after the age of two years as multiple bony growths on the appendicular skeleton. As a rare condition (incidence of 0.9-2/100,000), it is not commonly seen in our environment. This paper presents the clinical and radiological features of two patients seen in our hospital within a period of six months. Method: The case records of two patients with hereditary multiple exostoses are presented to highlight the clinical presentation and management options of the condition. Results: A boy and a girl who respectively manifested the features of hereditary multiple exostoses at the age of two and six years are presented. The main presenting features were painless progressively increasing bony swellings in both upper and lower limbs, with forearm deformity and ulnar deviation of the wrist. One of them had pressure symptoms which necessitated surgical excision of the symptomatic exostosis. Fine needle aspiration cytology confirmed the diagnosis of osteochondroma. Conclusion: Hereditary multiple exostoses though rare, do occur in our environment and the management is essentially by masterly inactivity except when the bony swellings exhibit any complications or there is concomitant deformity.

Heterotopic gestations occurring in spontaneous conception cycles are rare. An incidence of 1 in 30,000 has been documented. However, there is a rising rate mostly attributed to ovulation induction and assisted reproduction techniques, where it occurs in 1 to 3% of all clinical pregnancies. A high index of suspicion and use of ancillary investigations will aid diagnosis. The management of this condition in a Jehovah's Witness presents an uncommon challenge as surgical intervention aims to salvage the intrauterine pregnancy whilst giving scrupulous attention to haemostasis. This is because blood transfusion is precluded in the management of haemorrhage in members of this sect. We present a case of heterotopic gestation that occurred spontaneously in a Jehovah's Witness; she had emergency salpingectomy and subsequently had spontaneous vertex delivery of a live baby at term.

Objective: To create awareness that giardiasis can mimic acute clinical symptomatologies and result in missed diagnosis Method: The case files of four acute and life threatening presentations that were misdiagnosed initially but later found to be Giardia lamblia infestations from laboratory stool results and responded to treatment for giardiasis were reviewed. Results: One of the cases was diagnosed as food poisoning, a second as a case of hypovolemic shock and the third also as a hypovolemic shock, though also considered to have sepsis and the last, a case of acute exacerbation of asthmatic attack. Three of the cases were less than 24 months and vomiting was seen in 3 of them. Conclusion: Giardiasis in childhood can be acute and life threatening and should be considered in such ill children, especially if they also have digestive system symptomatology.

Mucinous tumours are the second most common type of epithelial ovarian tumours. Majority of these tumours are benign. However, some of these benign lesion can grow to enormous size, thus stimulating malignant neoplasia. This report presents the case of a 35 year old grand multiparous woman who came to our gynaecological clinic with5year history of abdominal swelling associated with weight loss. Abdomino-pelvic ultrasound scan revealed a large left ovarian cyst. She had laparotomy with left oophorectomy. A huge mucinous cystadenoma weighing 33.6kg was removed. Her post-operative course was unremarkable.

Objective: Multiple familial trichoepitheliomas are rare autosomal dominant skin disease that is rarely reported from this part of the world. The lesions resemble other types of skin diseases that present with papules and nodules. Patient and Method: This is case report of a patient who presented with multiple facial papules and nodules. He wanted treatment to improve his facial (cosmetic)appearance. Results: A 36 year old single male with a 25 years history of multiple facial papules and nodules. Similar lesions were present in other members of the family. He had several treatments including that for leprosy. Histologically the lesions showed keratinized stratified squamous epithelium overlying proliferating packets of basoloid cells with hyper chromatic nuclei, along with several keratin horn cysts and moderate stromal infiltrate of chronic inflammatory cells. Based on the history and the histology a diagnosis of multiple familial trichoepithelioma was made. Conclusion: For a diagnosis of multiple familial trichoepithelioma to be made in patients presenting with multiple facial papules and nodules a high index of suspicion is needed. This is more so if there is a history of similar lesions in the family.

Uterine rupture during a first pregnancy is rare. We present the case of spontaneous intrapartum uterine rupture in a 40 year old primigravida with no prior uterine surgery, and a structurally normal uterus. The patient had obstructed labor. Operative findings were a male fresh stillbirth weighing 3800g, massive hemoperitoneum, and an anterior transverse rupture at the lower uterine segment. Repair of the rupture was done without bilateral tubal ligation. Although a rare event, the primigravid uterus is not immune to rupture as exemplified by this report.

We present a case of a 29 year old nulliparous woman with clomiphene resistance polycystic ovarian syndrome. She had a successful laparoscopic ovarian drilling (LOD) in a private fertility centre in Nnewi Southeast Nigeria. She achieved a pregnancy four months later following clomiphene citrate ovulation induction. The pregnancy was complicated with 1 ^st trimester threatened abortion, pre-term PROM and later pre-term labour at 34 weeks gestation with breech presentation. She had a successful caesarean delivery of a 1.75kg life female baby that was nursed in the incubator for 2 weeks before discharge. This is the first reported successful LOD in Southeast Nigeria with good pregnancy outcome.