Objective: To determine the proportion and causes of poor visual outcome of cataract operations done in a public hospital in southeast Nigeria and propose actions to improve the cataract surgical outcome. Method: A prospective observational analysis of the initial hundred cases of cataract operations done in Imo State University Teaching Hospital, Orlu between October, 2007 and June, 2009. The Manual Cataract Surgical Record System developed by the International Center for Eye Health, London was used. Consecutive patients undergoing cataract operation were examined on admission, at discharge, 4-8 weeks follow up and information entered in cataract surgical record forms was collated in manual tally sheets and analyzed. The WHO target guidelines on the visual outcome of cataract surgery were used. Result: Total of 108 eyes operated (100 available for 4-8 weeks follow up). All were extracapsular cataract extractions with intraocular lens implants. The proportions of cases with poor outcome were 19.5% at discharge and 9.0% at 4-8 weeks follow up. The causes of poor outcome at discharge were uncorrected refractive error 8.3%, surgical complications 7.4% and coexisting disease 3.7%. The causes of poor outcome at 4-8 weeks follow up were surgical complications 5%, coexisting disease 2% and post-operation sequelae 2%. Conclusion:There is need to improve the quality of cataract operations in the hospital. Recommended actions include provision of irrigation/aspiration cannulas, improved preoperative examination of cases, provision of biometry facilities and retraining of surgeons.

Objective: Neurofibromatosis type 1 is not an uncommon disorder, its prevalence is said to be around 1 in 2000-4000 live birth. It has diverse manifestations that may affect any part of the body and present to clinician of any specialty, however, little or no attention have been given to area of neurological, ophthalmological and auditory complications in these patients. This study is aimed at evaluating the clinical, histological presentation and to highlight the need of multi disciplinary approach in the management of this condition. Methodology: The case records of patients who presented with clinical signs and request form with histologically proven neurofibrom atosis were retrieved and reviewed from University of Maiduguri Teaching Hospital and Federal Medical Center Azare from January 2000-December 2005. The clinical characteristics, histological reports and complications were evaluated. Information such as the age, sex, site and histological diagnosis were extracted from the patient's case notes and histology request form. Results: Forty seven patients fulfill the diagnostics criteria of the national institute of health consensus development conference NIHCDC. The age range was 10-65yrs, with the mean of 27.85yrs. There were 23 males and 24 fern ales, sixteen patients had a positive family history of sim ilar condition in a first degree relative and three are from same parents. Forty one had cutaneous fibroma (87.2%) while 6 (12.8%) were plexiform. Twenty-nine patients had cafe a laic lesion (61.7%), while 30(63.8%) presented with axillaiy and or inguinal freckling. One of the cases presented with osseous lesion and hypertension. The commonest site of neurofibroma was the trunk 16(34%), head and face 11(23%), then the lower limb 10(21.8%). Treatment modality was mainly excision of neurofibroma. Conclusion:This study have documented that NF1 is not an uncommon disorder in this region and has no sex predilection and present commonly within the second and third decade of life when dermal neurobribroma start to occur in the skin; the trunk, head and face being the commonest area of affliction. Attention is to be paid to neurological, ophthal nological and auditory systems in the evaluation of the patients and to follow up these patients for a long time to evaluate the long term complications.

Objective and Background:The need to sanitize our environment from elements hazardous to life on earth is hereby high-lighted, as well as a properly organized and efficiently run prenatal health care system. Clinical Methods and Materials:From 1975 to 2004,17 spinal celes (including 2 meningoceles) were routinely repaired in Imo and Ebonyi States of Nigeria, and 5 in Jam aica,the West Indies; none in Easel, Switzerland. All 20 meningomyeloceles were incontinent of urine and faeces, had severe paraparesis to paraplegia, sensory loss in both lower limbs, and bilateral pedes equino-varus in 16 cases. In addition, 2 were hydrocephalic, andall meningomyeloceles were ulcerated. All celes were micllme. The meninggoceles were normal. The operations were carried out under routine general anaesthesia. Results: The pre-operation status remained the same in all 20 meningomyeloceles 60 months later, though, they were able to sit up and shift around on their buttocks. The meningoceles remain d norm al. The hydrocephalus in both cases was arrested. There were no deaths within the hospitalization period of about 14 days. Conclusion: Vigorous endeavor to sanitize our environment from obnoxious elem ents(env ironm ental pollution, hazardous waste sites, agricultural chemicals, organic solvents, water chsinfection by-products, etc.), good and adequate antenatal care, with antenatal diagnosis of the malformed foetus and termination of the pregnancy, must be strived at, folic acid supplementation must begin before conception.

Objective: This study was conducted to evaluate the prevalence of GTD and describe its clinical features and management in a tertiary level hospital inNnewi SoutheastNigeria. Methods: We studied retrospectively the cases of GTD that were proved histologically and managed in the department of Obstetrics and Gynaecology of Nnamdi Azikiwe University Teaching Hospital Nnewi over a 5 years period (200 - 2008). Results: The frequency of GTD inNnewi is 4.6 per 100 deliveries. Ten (66.7%) of the cases were choriocarcinoma while 5(33.3%) were hydatidiform mole. There was no case of invasive mole or placental site trophoblastic tumour (PSTT). The age range of the patients was 15 - 46 years with a mean of 31&@177; 8.6 years. There was no significant association between age and GTD (X² = 4.5; p = 0.609) and between Parity and GTD (x² =1.87; p = 0.171 ). Most of the patients (73.3%) presented in late second trimester and the comm onest mode of presentation was abnormal vaginal bleeding. The symphysio - fundal height was more than the estimated gestational age in 9(60%) of cases. All the patients made an earlier presentation in different peripheral hospitals and were managed as incomplete miscarriage prior to presentation in our hospital. The average duration of follow - up in these patients was 2.4 =3.2 weeks. Contraception use was documented in 3 (20%) of the patients. Conclusion: There was a high prevalence of GTD and notably choriocarcinoma. The associated mortality was high. There was lack of suspicion of the pathology among the primary healthcare providers. This study suggests that all cases of evacuation products should be subjected to histopathological examination. There is the need to emphasize the role of adequate and appropriate counselling in the management of the patients with GTD. Call and recall system should be introduced in the management of patients with GTD to improve their compliance to recommended management standard. This will improve the prognosis of the condition in our women.

Tension pneumothorax is a rare complication following an accidental kerosene poisoning. In such situation, a bed-side needle thoracocentesis is performed because of its potential of becoming fatal; hence its clinical importance. A case of 15 month old boy with tension pneumothorax following accidental kerosene poisioning that responded to needle thoracocentesis is presented.

Hyper-reactive malarial splenom egaly is thought to represent a dysfunctional immune response to recurrent malaria infection. A 14 year old male child with hms, hypersplenism, ascites and peripheral lymphadenopathy is reported. There was initial poor response to proguanil aggravated by non compliance. He was started on a combination of proguanil and chloroquine with counseling and showed good and fast response. A review of the management and recent concept of pathogenesis is presented.