Background: Despite advancements in airway management, treatment of fractures in the maxillofacial region under general anesthesia remains a unique anesthetic challenge. We reviewed the pattern of airway management in patients with maxillofacial fractures and assessed those challenges associated with the different airway management techniques employed. Materials and Methods: The anesthetic chart, theatre and maxillofacial operations records of patients who had reduction and immobilization of various maxillofacial fractures over a 2-year period were reviewed. Information obtained included the patient demographics, mechanisms of injury, types of fractures and details about airway management. Statistical Package for Social Sciences, SPSS version 17.0 was utilized for all data analysis. Results: Fifty-one patients were recruited during the 2-year study period. Mask ventilation was easy in 80-90% of the patients, 80% had Mallampati three or four, while 4 (7.8%) had laryngoscopy grading of 4. There was no statistically significant difference between the fracture groups in terms of the laryngoscopy grading (P = 0.153) but there was statistical significant difference in the technique of airway management (P = 0.0001). Nasal intubation following direct laryngoscopy was employed in 64.7% of the patients, fiber-optic guided nasal intubation was utilized in only 7.8%. None of the patients had tracheostomy either before or during operative management. Conclusion: Laryngoscopic grading and not adequacy of mouth opening predicted difficult intubation in this group of patients in the immediate preoperative period. Despite the distortions in the anatomy of the upper airway that may result from maxillofacial fractures, nasal intubation following direct laryngoscopy may be possible in many patients with maxillofacial fractures.

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Gallstone disease is a worldwide medical problem, but the incidence rates show substantial geographical variation, with the lowest rates reported in African populations. Publications in English language on gallstones which were obtained from reprint requests and PubMed database formed the basis for this paper. Data extracted from these sources included authors, country, year of publication, age and sex of patients, pathogenesis, risk factors for development of gallstones, racial distribution, presenting symptoms, complications and treatment. Gallstones occur worldwide, however it is commonest among North American Indians and Hispanics but low in Asian and African populations. High biliary protein and lipid concentrations are risk factors for the formation of gallstones, while gallbladder sludge is thought to be the usual precursor of gallstones. Biliary calcium concentration plays a part in bilirubin precipitation and gallstone calcification. Treatment of gallstones should be reserved for those with symptomatic disease, while prophylactic cholecystectomy is recommended for specific groups like children, those with sickle cell disease and those undergoing weight-loss surgical treatments. Treatment should be undertaken for a little percentage of patients with gallstones, as majority of those who harbor them never develop symptoms. The group that should undergo cholecystectomy include those with symptomatic gallstones, sickle cell disease patients with gall stones, and patients with morbid obesity who are undergoing laparotomy for other reasons.

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Background: Vacuum-assisted closure (VAC) therapy has been shown to be beneficial in a variety of wounds. However, evidence of its benefit in diabetic foot ulcers (DFUs), especially with respect to Indian population, is sparse. Methodology: This randomized controlled trial included DFUs of Wagner's Grades 1 and 2. Patients were further stratified with respect to DFU size <10 cm and ≥10 cm. Patients with vascular disease, osteomyelitis, and bilateral DFUs were excluded from the study. The enrolled patients were randomized to receive VAC therapy or conventional dressing. The time to wound healing, granulation tissue formation, and complications such as pain, infection, and bleeding were compared between the two groups. Results: A total of sixty patients were randomized, of which 27 in each group were analyzed. The mean time to healing in days was significantly less in VAC group (22.52 vs. 3.85; P < 0.0001). Mean time to achieve 75%–100% granulation tissue cover was significantly less in VAC group (23.33 vs. 32.15; P < 0.0001). Rate of granulation tissue formation was also found to be significantly better in VAC group (2.91 cm²/day vs. 2.16 cm²/day; P = 0.0306). There was no difference between the two groups with respect to wound infection and bleeding which are commonly attributed to VAC therapy. VAC therapy group had significantly lesser pain at week 3 (Visual Analog Scale score 3 vs. 4; P = 0.004). Conclusion: VAC therapy significantly decreases the time to complete wound healing, hastens granulation tissue formation, and reduces the ulcer area compared to conventional dressing. The study did not find any significant increase in the bleeding and infection in the VAC therapy group.

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Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in Nigeria. The government should take measures to combat transplantation tourism and the problem of national and international trafficking in human tissues and organs, ethics commission and National Transplant registry should be established in order to monitor and regulate the programme in the country.

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Introduction: Benign prostrate hyperplasia (BPH) is a leading source of healthcare problem in aging men around the world including India. Both International Prostate Symptom Score (IPSS) and New Visual Prostate Symptom Score (VPSS) are used to assess the lower urinary tracts symptoms (LUTSs) in men. The present study was planned to compare these two scores, IPSS and VPSS in Indian rural men prospectively and their efficacy was compared with urodynamic evaluation of the patients. Materials and Methods: With Institutional Ethical Committee approval, this study was conducted on 100 patients having LUTS and BPH after obtaining written informed consent. Patients' educational status was noted. All the patients were requested to complete the IPSS and VPSS questionnaire, and they were correlated. The urodynamic study was performed on all the patients with uroflowmeter. Two parameters of uroflowmetry, Q _max (maximum urine flow rate expressed in ml/s) and Q _avrg (average urine flow rate expressed in ml/s) were measured and correlated. Results: Most of the patients (55%) in this study were uneducated. Out of 100 patients, 83% were able to fill the VPSS questionnaire without assistance as compared to only 40% patients in IPSS questionnaire (Z = 6.557, P < 0.001). There was a positive correlation between IPSS and VPSS total score in this study (r = 0.453 and P ≤ 0.001). It was noticed that IPSS Question 2 for frequency of urination had a positive correlation with VPSS Question 1 (day time frequency of urination) r = 0.645 (P = 0.000). Similarly, IPSS Question 7 for night frequency when compared with VPSS Question 2 (nocturia); the value for r was found to be 0.536 (P = 0.000).The IPSS Question 5 for straining when compared to the VPSS Question 3, i.e., the question for the strength of stream during micturition; the positive correlation was found to be 0.266 (P = 0.007). There was a negative correlation between IPSS total score and Q _avrg with value − 0.368 (P = 0.000) and between IPSS total score and Q _max of − 0.433 (P = 0.000). A negative correlation is also noted between VPSS total score and Q _avrg of value 0.497 (P = 0.000) and VPSS total score and Q _max of value − 0.719 (P = 0.000). Conclusion: VPSS correlates significantly with the IPSS to quantify the LUTS due to BPH. The VPSS can be used instead of the IPSS for the assessment of symptom severity in men with LUTS, who are illiterate or have limited education.

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Objective: To assess the efficacy and safety of the selective a!-blocker doxazosin in black men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia. Patients and Methods : An open-label study involving consecutive patients with benign prostatic hyperplasia. They were asked to complete the International Prostate Symptom Score (IPSS), with its eighth question (bother score) and perform basic uroflowmetry. The study involved the use of doxazosin for the treatment of symptomatic benign prostatic hyperplasia in three phases. Phase 1 of washout period/enrolment, a two weekly interval titration phase and a maintenance phase for four weeks. The symptom score (IPSS), bother score and uroflowmetry were used to evaluate the severity of the condition and the efficacy of the drug. Results: Twenty-four patients were enrolled into the study, only 18(75%) completed the eight-week study. The ages of the patients ranged between 46 years and 82 years with a mean of 66 years. (SD, 10.0) Fourteen patients were stabilized on 4mg doxazosin while the remaining 4 patients had 2mg. There was significant improvement of the symptoms, with a remarkable sharp decline after two weeks of medication in IPS S by 8 points from baseline. The improvement was sustained over the following six weeks period. The bother score (quality of life index) was similarly observed to decline from a mean of 4.7 at baseline to 1.3 at the end of the study. The clinical trial showed a significant increase in the urine flow rate with an improvement of 4mls/second from baseline and a 24.1 % increase in voided volume. There was no adverse event recorded in all the patients to warrant discontinuation of the study. Conclusion: Doxazosin is an effective and well tolerated drug in the treatment of symptomatic BPH inNigerians.

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Background: Prostate cancer is the most common cancer among Nigerian men and the second most common cause of death from cancer in men worldwide. The aim of this study was to assess the level of awareness of prostate cancer among men attending the various outpatients' clinics of the Lagos State University Teaching Hospital, Ikeja. Materials and Methods: This study is a descriptive cross-sectional study. Self-administered structured questionnaires were used to collect information from consecutives patients attending the various outpatient clinics of the hospital. Results: One hundred and forty-six respondents with an age range of 40–80 years participated in this study. Sixty-nine (47.3%) respondents were aware of prostate cancer while 77 (52.7%) have never heard of the disease. Twenty (13.7%) participants were aware of the availability of a screening test for the disease and only 12 (8.2%) have had any form of screening for prostate cancer. Conclusion: There is a low level of awareness of prostate cancer among patients seen at our center and also level of voluntary screening for the disease is low.

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Context: The surgical management of fistula-in-ano is still debatable and no clear recommendations have been made available until now. The present study analyses the results of ligation of intersphincteric fistula tract (LIFT) technique in treating fistula-in-ano in particular with recurrence, healing time, and continence status. Aims: LIFT in the management of patients of fistula-in-ano of cryptoglandular origin. Settings and Design: Prospective study. Materials and Methods: This is a prospective study of 52 patients admitted from September 2012 to August 2014. Patients were managed with LIFT technique and results of LIFT technique were compared with other studies in terms of recurrence rate, incontinence rate, and other postoperative complications. Results: A total of 52 patients were studied. Median follow-up was 24 weeks. Primary healing was achieved in 32 (71.11%) patients. Thirteen patients (28.88%) had a recurrence. No patient reported any subjective decrease incontinence after the procedure. Conclusions: LIFT technique is simple and easy to learn. With this method fistula-in-ano could be easily treated even at primary health care level. LIFT technique is a simple and novel modified approach for the treatment of fistula-in-ano with rapid healing rate and without any resultant incontinence.

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Background: Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. Methods of Study: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. Results: A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture of the perianal abscess. 6 (60%) of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients. Another 30% had fistulotomy and continuing sitz bath. Conclusion: Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier's gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.

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Aims and Objectives: The objectives of this study were to analyze the different reasons why patients with fractures patronize traditional bone setters (TBS) and their impression of the outcome of the treatment by the TBS. Materials and Methods: A 24 month prospective observational study was conducted from February 2012 to January 2014. All the patients were recruited from the orthopedics outpatient clinic. The demographic data of each patient, the type of injury, presentation to hospital or not, reasons for leaving the hospital, reasons for patronage of the TBS and their impression of the outcome of TBS' treatment, effect of educational background on patronage of TBS and reason for presenting to hospital for orthodox treatment. Data Analysis: Analysis was done with SPSS software Version 20. Results: A total 79 patients were recruited for the study and they had different reasons for patronizing TBS. These reasons include an external locus of decision making in 19 (24.1%) patients, and greater faith in TBS compared to orthodox medicine in 16 (20.3%). Twelve (15.2%) believed that TBS are more competent than orthodox medical practitioners while another group 11 (13.9%) considered the fees of TBS cheaper than those in the hospital. The delay in treatment in the hospital, forceful removal of patients from hospital against their will and nonsatisfaction with hospital treatment accounted for 5 (6.3%). Poor attitude of hospital staff, fear of amputation, and patients being unconscious during the injury accounted for 2 (2.5%). Their ages ranged from 17 to 83 years, with mean age of 36.8 ± 11.8 years. The male: female ratio was 1.5:1. Conclusions and Recommendations: With recent advancements in the practice of orthopedics and trauma, there is still a very high patronage of the TBS by most of our patients. This is largely due to the dependence of the patients on their sponsors for treatment, while the influence of cultural and religious beliefs continues to play a major role in these decisions.

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Dental implants have been used in a variety of different forms for many years. Since the mid-20 ^th century, there has been an increase in interest in the implant process for the replacement of missing teeth. Branemark was one of the initial pioneers who applied scientifically based research techniques to develop an endosseous implant that forms an immobile connection with bone. The need for a dental implant to completely address multiple physical and biological factors imposes tremendous constraints on the surgical and handling protocol. Metallic dental implants have been successfully used for decades, but they have serious shortcomings related to their bony union and the fact that their mechanical properties do not match those of bone. However, anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement of the implant facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an aesthetic outcome. Therefore, it is advisable to establish a logical continuity between the planned restoration and the surgical phases, it is essential to use a transfer device that for sure increases the predictability of success. The surgical guide template is fabricated by a dental technician after the presurgical restorative appointments that primarily include determination of occlusal scheme and implant angulations. Here, authors genuinely attempted to review the evolution and clinical applicability of surgical templates used in the placement of dental implants.

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Introduction: The hydatid disease most often involves the liver and the lungs. The disease can involve any part of the body except the hair, teeth and nails. Primary extrahepatico-pulmonary hydatid cysts are rare and only a few sporadic cases have been reported. Materials and Methods: Two hundred and forty-four patients with hydatid cysts managed surgically from January 2005 to December 2009 were evaluated retrospectively. Fourteen (5.7%) patients had isolated involvement of the atypical sites, while six (2.4%) also had a primary involvement of liver. Results: The cysts were present in gall bladder (0.4%), peritoneum (1.6%), spleen (1.6%), ovary (0.4%), subcutaneous (0.8%), seminal vesicle (0.4%), spinal (0.4%), pancreas (0.4%), kidney (0.4%), mediastinal (0.4%), muscle (0.4%), and brain (0.8%). Discussion and Conclusions: Involvement of sites other than liver and lungs by hydatid disease is rare. Symptoms are related to size, location or possible complication of the cyst. It should be strongly suspected in differential diagnosis of all abdominal cysts especially in an endemic area. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.

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Objective: The objective of this study is to compare the safety of early versus delayed oral feeding after uncomplicated cesarean section (CS) under spinal anesthesia. Methods: This was a randomized, controlled trial that enrolled 152 women who had uncomplicated CS under spinal anesthesia between January 2014 and June 2014. Women in the early feeding group had sips of oral fluid 6 h postoperatively while those in the delayed feeding group were on nil per oral for the first 24 h after surgery before commencement on liquid diet. Primary outcome measure was development of symptoms of paralytic ileus while secondary outcome measures included time interval to return of bowel sound, duration of hospital stay, and patients satisfaction which was determined using a visual analog score. Results: The incidence of mild ileus symptoms was similar in both groups. Early-fed group had significantly shorter mean postoperative time intervals to return of bowel sound, (7.3 h vs. 11.5 h [P = 0.005]), passage of flatus, (30.7 h vs. 37.5 h [P = 0.009]). Hospital stay was also significantly shorter in the early feeding group, (4.2 days vs. 4.9 days [P < 0.001]). Early-fed women had higher levels of satisfaction. Conclusion: Early initiation of oral feeding after uncomplicated CS under subarachnoid block is not associated with increased incidence of gastrointestinal symptoms or paralytic ileus.

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Stem cells are primitive cells that can differentiate and regenerate organs in different parts of the body such as heart, bones, muscles and nervous system. This has been a field of great clinical interest with immense possibilities of using the stem cells in regeneration of human organ those are damaged due to disease, developmental defects and accident. The knowledge of stem cell technology is increasing quickly in all medical specialties and in dental field too. Stem cells of dental origin appears to hold the key to various cell-based therapies in regenerative medicine, but most avenues are in experimental stages and many procedures are undergoing standardization and validation. Long-term preservation of SHED cells or DPSC is becoming a popular consideration, similar to the banking of umbilical cord blood. Dental pulp stem cells (DPSCs) are the adult multipotent cells that reside in the cell rich zone of the dental pulp. The multipotent nature of these DPSCs may be utilized in both dental and medical applications. A systematic review of the literature was performed using various internet based search engines (PubMed, Medline Plus, Cochrane, Medknow, Ebsco, Science Direct, Hinari, WebMD, IndMed, Embase) using keywords like "dental pulp stem cells", "regeneration", "medical applications", "tissue engineering". DPSCs appears to be a promising innovation for the re-growth of tissues however, long term clinical studies need to be carried out that could establish some authentic guidelines in this perspective.

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Distal ureteric stricture is a common complication of urinary schistosomiasis which is a disease more prevalent in the tropics and subtropics. The surgical management of this complication is more challenging when it affects more than half of both ureters. We report the case of a 17-year-old Nigerian with a long standing recurrent painless terminal hematuria associated with bilateral colicky loin pains. Ultrasound scan showed bilateral hydro ureters and hydro nephrosis with deranged biochemical renal function. The patient had bilateral tube nephrostomy and antibiotic therapy. Definitive bilateral ureteric substitution was done using Mitrofanoff technique for the right ureter and Yang-Montie technique for the left ureter. The patient's renal function became normal and he was discharged home without complication. The related literatures were reviewed. Surgical nonurothelial ureteral substitution is necessary for long, extensive, severe bilateral ureteric strictures so as to prevent progressive renal damage and end stage renal failure.

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Introduction: Breast cancer is leading cancer in women, and the incidence of breast cancer in India is on the rise. The most common histologic type of breast cancer is infiltrating ductal carcinoma. Prognostic and predictive factors are used in the management of breast cancer. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2/neu) are immunohistochemical markers of prognosis as well as predictors of response to therapy. Aims and Objectives: The study was conducted to evaluate ER, PR, and HER2/neu expressions in invasive ductal carcinomas of the breast by immunohistochemistry, to explore the correlation of these markers to each other and to various clinicopathological parameters: age of the patient, histological grade, tumor size, and lymph node metastasis. Materials and Methods: This prospective study was conducted on 100 cases of infiltrating ductal carcinoma. Slides were prepared from blocks containing cancer tissue, and immunohistochemical staining was done for ER, PR, and HER2/neu expressions. Interpretation of expressions was done using Allred scoring system for ER/PR and the American Society of Clinical Oncology/College of American Pathologists guidelines for HER2/neu. Statistical analysis was performed to determine the statistical significance by applying Chi-square test. Results: Majority of tumors were ER and PR positive and HER2/neu negative. ER and PR correlated significantly with age, tumor size, and tumor grade; whereas, HER2/neu correlated significantly with tumor size only. No association was seen with axillary lymph node metastasis. ER and PR expression correlated with each other, but none correlated with HER2/neu. Conclusions: As the majority of the tumors are ER, PR positive and since ER and PR correlate with each other as well as with age, tumor size, and grade. Therefore, routine assessment of hormone receptors is recommended for prognostic and therapeutic information in breast cancer cases.

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Urinary bladder is a known content of sliding inguinal hernias but rarely presents as irreducible direct inguinal hernia. As inguinal hernia repair is commonly undertaken even at peripheral surgical centers. Cystogram a simple radiological investigation (picturesque view) is useful for pre-surgical evaluation as it can prevent iatrogenic bladder injury during inguinal hernia repair. This investigation can be performed where other radiological expertises like computerized tomography scan/magnetic resonance imaging or even ultrasound facilities are not readily available.

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Introduction: Acute mesenteric ischemia (AMI) is the sudden onset of small intestinal hypoperfusion, which can be due to reduction or cessation of arterial inflow. It can be embolic or thrombotic. AMI is a potentially fatal vascular emergency, with overall mortality of 60%–80%. The present study was designed to study presentation, risk factors, and various outcomes of AMI patients, who were treated in the tertiary hospital. Methodology: All patients with features suggestive of AMI were taken in study. All patients underwent explorative laparotomy with exteriorization of bowel after initial resuscitation. Postoperatively, refeeding enteroclysis was done. Observation and Results: The total mortality rate was 62.50%. In patients with functional bowel length of 1 foot, 90.90% patients died. In patients with functional bowel length of 5–6 feet, only 12.50% died. It was observed that the mortality rate was more in the age group of 50–59 years with functional bowel length of 1 foot or <1 foot. Refeeding enteroclysis is an effective technique to use distal bowel. Contrast-enhanced computed tomography of the abdomen more suggestive of this pathology. Conclusions: A strong clinical suspicion and an aggressive approach should be considered in dealing with this condition because the outcome mainly depends on rapid diagnosis and treatment. With understanding of the pathogenesis of AMI and the better utilization of available radiological investigations, an improved outcome can be achieved. Mortality rates with refeeding enteroclysis are comparable with that of bowel anastomosis. This condition needs future research.

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Aim/Objective: To determine the pattern of morbidity and outcome among patients referred to the Pediatric Surgery Unit of the Lagos University Teaching Hospital (LUTH) following circumcision. Materials and Methods: Retrospective descriptive study of all patients with complications of circumcision who were managed in LUTH between 2008 and 2010. Results: There were 36 patients. The age range was between 2 days and 9 years (median-3 months). Fifteen cases (42.9%) were due to urethro-cutaneous fistula while there were six cases (16.7%) of postcircumcision bleeding. There were four cases (11.1%) each of partial penile amputation and buried penis. There were also cases of meatal stenosis, penile implantation cyst and glanulo-preputial skin bridge. With respect to the treatment offered, eleven (30.6%) patients had urethroplasty for the urethro-cutaneous fistulae while seven (19.4%) patients had penile refashioning for the buried penis and penile amputation. Appropriate surgical treatments were performed for the other complications. Conclusion: Urethrocutaneous fistula and penile amputation are the commonest complications of circumcision for which referral is made to LUTH. Treatment outcome was satisfactory. Health education and legislation to ensure procedure is performed by qualified medical and paramedical staff may reduce the morbidity.

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Objectives: The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria. Patients and Methods: A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients' records. This information include patients' demographics (age and sex) as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications. Result: There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD) 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%). Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients) and postoperative wound infection (eight patients) were the most common complications recorded. Conclusion: The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care contributed to the good outcome.

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Background Missing intrauterine contraceptive device (IUCD) is a known complication of IUCD use. Objective To examine the methods of diagnosis and Management modalities of missing IUCD at the University of Nigeria Teaching Hospital, Enugu. Materials and Method This was a retrospective review of the records of all clients who presented with complaints of missing IUCD over an 11 year period, from 1 ^st January 1990 to 31 ^st December 2000. Relevant information on biodata, methods of diagnosis and removal were extracted and analysed using tabulations and simple percentages. Results A total of 44,975 clients were seen at the family planning clinic within the period under review. Twenty two thousand, one hundred and sixty eight clients used IUCD, giving a 55.96% of total contraceptive use. Of these, 20 IUCD missed, giving the incidence of missing IUCD as 0.08%. The mean age of clients with missing IUCD was 38±2.18 years and the mean parity was 6.00 ± 0.54. Majority (30%) were asymptomatic. Twenty five percent presented with lower abdominal pain. One client had a co-existing pregnancy of about 10 weeks. The commonest mode of diagnosing missing IUCD was the use of plain abdominal x-ray with a marker in-utero (50%) and retrieval hook was used for removal in 45% of the cases. Three patients had exploratory laparotomy for removal of the missing IUCD. Conclusion IUCD is a method of contraception most commonly used in UNTH, Enugu. Plain abdominal x-ray with a marker in-utero is a simple and reliable diagnostic technique for missing IUCD.

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Background: Patients with breast pain are likely to be very worried because some consider pain in the breast as an indication of malignancy. Objective: To highlight the causes of pain in the patients are presenting to our breast clinic. Materials and Methods: A prospective study of all consenting patients with breast disease presenting to the breast clinic was conducted from January 2004 to December 2008. Results: A total of 664 patients presented to the breast clinic during the study period. Of this number, 127 presented with breast pain either as the sole symptom or in association with other symptoms. The presenting complaints were a pain, pain with lump, and pain with nipple discharge in 63 (49.6%), 59 (46.4%), and 5 (4.0%) patients, respectively. The pain was noncyclical in 96 (75.6%) patients. The site of the pain was whole breast in 87 (68.5%) patients and a lump in 40 (31.5%). The clinical diagnosis in 31 (24.4%) cases was fibrocystic disease, 28 (22.0%) cancer, 23 (18.1%) unknown, 10 (7.9%) fibroadenoma, 8 (6.3%) duct ectasia, 6 (4.7%) normal breast, and others 21 (16.5%) cases benign diseases were diagnosed. The histological diagnosis was fibrocystic changes, carcinoma, and fibroadenoma in 15 (42.9%), 10 (28.6%), and 5 (14.3%) patients, respectively. Others were benign phyllodes, abscess, duct ectasia, chronic mastitis, and lipoma, each constituting 1 (2.9%) case. Conclusion: Breast pain constitutes a small proportion of complaints to our breast clinic. Fibrocystic changes were the most common cause of breast pain both clinically and histologically.

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Background: COVID-19 pandemic has affected surgical practice worldwide. Laparoscopic procedures utilizing gas for pneumoperitoneum require specific consideration. Method: A panel of experts of the Laparoscopic Surgery Society of Nigeria (LASSON) was constituted to draft recommendations on the conduct of minimal access surgical (MAS) procedures during and after the pandemic in Nigeria. Results: The Society strongly believes that laparoscopy and other (MAS) procedures can be safely performed during and after the current COVID-19 pandemic if appropriate safety measures are adhered to. The Society therefore makes the following recommendations for all units performing MAS in Nigeria: (1) Design clear cut measures to navigate the pandemic in each hospital. (2) Triage surgical services and procedures. (3) Encourage screening and testing of all patients (4) Provide adequate patient communication and consenting (5) Ensure compulsory use of Personal Protective Equipments (PPEs) (6) Minimize preoperative and intraoperative personnel (7) Envisage postoperative respiratory challenges and make adequate preparation for respiratory support: (8) Make specific considerations for the confirmed COVID 19 positive patients:(9) Private facilities offering MAS and endoscopic procedures should take special measures during the pandemic (10) Know your limits. Conclusion: The Society encourages all MAS practitioners to adhere to these recommendations.

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Tuberculosis is considered as ubiquitous disease as it involves any organ, but primary involvement of abdominal muscles is very rare. In most cases, the muscle involvement is secondary and is caused by either hematogenous route or direct inoculation from a tuberculous abdominal lymph node or extension from underlying tubercular synovitis and osteomyelitis. Autopsy studies have shown abdominal wall involvement in less than 1% of patients who died of tuberculosis. Antitubercular therapy is main form of management. Surgical intervention is always secondary in the form of either sonography or computerized tomography-guided aspiration or open drainage which is usually reserved for patients in whom medical treatment has failed. A case is hereby reported about primary tubercular anterior abdominal wall abscess without any evidence of pulmonary, skeletal or gastrointestinal tuberculosis in an apparently healthy individual with any past history of contact or previous antituberculosis therapy.

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