The treatment of ocular pterygium has been subjected to the development and application of various new strategies in the last few years. The worrisome problem of recurrence seems to have been significantly reduced with the newer methods of treatment. The field is however, still evolving. This review sets out to examine the various newer approaches to treating pterygium and in spite of the recent developments, to highlight the remaining challenges thereby suggesting the possible direction of future research. Also, to suggest treatment options for Ophthalmologists working in environments with limited resources. A library search and Internet search of PubMed and Google was conducted in 2010. Search terms included "pterygium in combination with surgery", "radiotherapy", "chemotherapy", "graft", and "recurrence." Abstracts were reviewed and relevant articles especially those published from the year 2000 to date were given more attention and when possible, reviewed in full. The relevant references in such articles were also reviewed. In conclusion, excision and adjunctive treatment with mitomycin C or conjunctival autograft is the most acceptable and most popular mode of treating both primary and recurrent pterygium. Outcomes seem to have been further improved with adjuvant combination therapy and the introduction of newer approaches to treatment.

Background: As women increasingly delay child bearing, the proportion of women having their first delivery at ''advanced maternal age'' is expected to rise. These elderly primigravidae have traditionally been considered to be at increased risk of adverse maternal and perinatal outcomes because of associated pregnancy and labor complications and, therefore, need to be evaluated. Aim: To determine the prevalence of elderly primigravidae and compare their pregnancy outcome with that in younger primigravid mothers in Port Harcourt. Materials and Methods: It was a two-year retrospective case-controlled study. The study population consisted of all primigravid mothers aged 35 years and above (elderly primigravidae) who delivered at the University of Port Harcourt Teaching Hospital (UPTH) between 1 ^st January, 2005 and 31 ^st December 2006, and the control group consisted of all other primigravid women less than 35 years of age. Selected maternal and perinatal sociodemographic characteristics and other outcome variables were extracted from patients' case notes. The data were entered into a personal computer and analyzed using SPSS version 11.0. The χ² - test was used for comparison of both groups and statistical significance set at P < 0.05. Results: Of the 5147 parturients who delivered during the study period, 74 (1.4%) were elderly primigravidae. They constituted 4.7% of all primigravidae. The caesarean delivery rate (58.1% vs 32.1%, P = 0.001), preterm delivery rate (10.8% vs 5.1%, P = 0.03), and fetal macrosomia rate (16.2% vs 6.6%, P = 0.002) were significantly higher in the elderly primigravidae than the younger primigravid controls. There were no significant differences in the other maternal and perinatal outcome measures. Conclusion: The prevalence of elderly primigravidae in our centre is 1.4%. The elderly primigravidae are at increased risk of preterm, macrosomic, and caesarean deliveries compared to their younger primigravid counterparts.

Background: Despite the benefits of regular follow-up in the long-term care of asthma, no previous study has reported on it among asthma patients in Nigeria. Objective: This survey was designed to evaluate GP-reported follow-up visits among asthma patients in North Central Nigeria. Methods: It was a cross-sectional survey conducted among GPs in three North Central states of Nigeria. Results: Overall, 48.3% of the GPs reported that their patients usually come for follow-up visits. About 63.6%, 40.0%, and 55.3% of the GPs in Kwara, Kogi, and Niger states, respectively, reported that their patients came for follow-up visits in the month prior to this study. Less than two-third of GPs in both private (55.1%) and public (56.8%) hospitals reportedly attended to patients on follow-up visits. About 46.5%, 37.5%, and 52.0% of the GPs who attended to patients <1 week, 1-2 weeks and >2 weeks prior to the study reported that their patients came for follow-up visits. There was significant difference (P = 0.04) in the reported follow-up visits by GPs who attended to ≥10 asthma patients compared to others. None of the nine GPs who reportedly treated ≥ 10 patients in the preceding month of the study attended to any patient on follow-up visits. Conclusion: The GP-reported rates of follow-up visits in patients that are accessing asthma care from GPs practicing in the North Central part of Nigeria are low. Further studies to identify barriers to follow-up visits and how to correct them are therefore recommended.

Background: The aim of the study is to evaluate the pattern of presentation and the mode of management of retinoblastoma seen in Aminu Kano Teaching Hospital, Kano from 2001 to 2005. Materials and Methods: The clinic register was used to obtain the case folders of all children treated for retinoblastoma and this was used to obtain information on patient's age, sex, and clinical sign(s) at presentation such as orbital mass, leucocoria, proptosis, hyphaema without history of trauma, unexplained hypopyon, or uveitis. Also documented were X ray/B mode ultrasound scan findings, type of surgery performed, histological diagnosis, and adjuvant chemotherapy where applicable. Results: Forty-two patients were reviewed, 15 males and 27 females (M: F = 1.0: 1.8). The age ranged between 2 and 6 years and the peak age of presentation was 3 years in 22 patients (52%). The tumor was unilateral in 40 patients (95%) and bilateral in 2 patients (5%). Most of the patients (46%) presented late with fungating orbital mass. Other signs include leucocoria 22%, proptosis 19%, hyphema 7%, Hypopyon 2%, squint 2%, and buphthalmos 2%. Thirty-one patients (74%) had exenteration and enucleation was performed in 11 patients (26%). The tumor was histologically confirmed in 41 patients (98%) and was poorly differentiated in 23 patients (55%), 1 patient (2%) had toxocara granuloma. Thirty-nine patients required adjuvant chemotherapy and only 2 received 6 (full) courses. Conclusion: Retinoblastoma, a treatable tumor is characterized by late presentation as illustrated in our study. There is need to create public awareness and educate mothers on this tumor so that there is early diagnosis, appropriate referral, and prompt treatment. The goal is to increase number of children successfully cured of this disease in our environment.

Background and Objectives : To investigate the effect of extracorporeal shock waves on the healing of intestinal anastomosis. Materials and Methods : Thirty Wistar rats were randomly divided into three groups of ten each comprising of Group I (only laparotomy), Group II (right colon segment resection and end to end anastomosis) and Group III (right colon segment resection and end to end anastomosis). Group III animals a total of 1200 impulse 0.12 mj/mm ² shock waves on the post-operative 3 ^rd , 5 ^th and 7 ^th days in three session each of which included 400 impulse with 14KV. On the 10 ^th post operative day, the rats were sacrificed and postmortem examination was done. The explosion pressures were measured using a sphygmomanometer specially designed for this purpose. In the study groups 4 cm intestine segments which include anastomose line was taken out. The segments which include anastomosis of the study group and the control group pieces were histopathologically examined. The fibroblast, collagen, angiogenesis and inflammatory cells were studied. Results : The mean anastomoses explosion pressure for group III was 272 ± 7.895 and the average anastomose explosion pressure was 220 ± 6.831. The difference between the pressure means was significant ( P < 0.05). Histological fibroblast/collagen ratio were 14.50 ± 5.66, 274 ± 66.21 and 416 ± 52.44 for Group I, Group II and Group III, respectively. The vein amount was 5.80 ±3.19, 51.20±10.76 and 75.10±13.80, respectively. In Group III, fibroblast/collagen and vein ratio was significantly higher compared to Group I and II ( 3.19, 51.20 ± 10.76 and 75.10 ± 13.80, respectively. In Group III, fibroblast/collagen and vein ratio was significantly higher compared to Group I and II ( P < 0.05). Conclusion : From the results of our study, extracorporeal shock waves treatment (ESWT) increase the intestinal tensile strength and may be useful to enhance the mechanical strength of anastomosis of the colon during healing.

Background: Hyperthermic Intraoperative Peritoneal Lavage (HIPL) is useful for bacterial decontamination and prevention of hypothermia during damage-control surgery (DCS). Little is known about the effect of HIPL on intra-abdominal pressure (IAP) alone or in combination with peritonitis. Aim: To determine the effects of HIPL at graded temperatures on IAP in the context of DCS. Materials and Methods: A total of 40 rabbits randomly assigned to aseptic-thermal (AT) and peritonitis-thermal (PT) groups and subgroups underwent HIPL at 40°C, 43°C, 46°C, and 49°C. The AT subgroup assigned 40°C was the control group. HIPL was done with a volume of 100 ml/kg. Hourly IAP measurement by two independent observers who were mutually blinded was done through a peritoneal balloon pouch connected to a manometer for 12 hours. Results: All rabbits in group AT survived for at least 11 hours, while all the rabbits in group PT died between 4 and 8 hours. There was significant IAP rise at 4 hours in all subgroups in comparison with the control (I _AT40 ): III _AT46 ( P < 0.01), IV _AT49 ( P < 0.001), V _PT40 ( P < 0.01), VI _PT43 ( P < 0.01), VII _PT46 ( P < 0.001), and P ₄₉ ( P < 0.001) except II _AT43 ( P = 0.85). Multiple linear regression analysis showed a positive correlation: Coefficient of regression {r = 0.85 (AT) and r = 0.89 (PT)} and coefficient of determination {r ² = 0.73 (AT) and r ² = 0.80 (PT)}. Conclusion: Our findings suggest that beyond 3°C above the normal body temperature in this species, HIPL acts synergistically with peritonitis to exacerbate intra-abdominal hypertension and is associated with a shortened survival postoperatively due to abdominal compartment syndrome.

Background : New drugs and new modalities for intraoperative pain relief is the current trend in pain management. Aim : The study aims at examining the current trend in intraoperative pain relief in patients of pediatric age at the University of Benin Teaching Hospital (UBTH) and its implications for a developing economy such as Nigeria. Materials and Methods : A retrospective study of 652 patients of pediatric age undergoing various surgical procedures was carried out in UBTH, Nigeria from January 2006 to June 2008. The intraoperative pain relief methods were documented including demographic data, anesthetic technique, associated morbidities and outcome. Results : Old generation opioid drugs and old modalities of pain relief including intravenous routes (573 i.e. 87.9%) and caudal blocks (46 i.e. 7.1%) were used in the intraoperative period in pediatric patients studied in UBTH. Adverse events of respiratory depression and hypotension including tachycardia and hypertension from ineffective analgesia were found in 14 patients (2.1%). The anesthetic technique was mainly general anesthesia for surgical procedures which were mainly laparotomies and urogenital surgeries. Conclusion : The study revealed a lagging behind trend in intra-operative pain relief for pediatric surgical patients in UBTH. This has enormous implications of increased costs of drugs, equipment, facilities and the training and skills acquisition of physicians and other relevant health care personnel in the development ofpediatric acute pain service (PAPS) whose current trend worldwide is information technology based. This current trend also includes the increased use of regional blocks including nerve blocks. These avoid the side effects of conventional parenteral opioids and leads to improved patient safety and outcome.

Introduction: The attitude towards people with epilepsy is influenced by the level of their knowledge about the condition. Parents usually do not accept the diagnosis of epilepsy in their children easily. This study was to assess 280 parents' knowledge and their attitude toward children suffering from epilepsy by answering a questionnaire. Aim: To evaluate the knowledge and attitudes of parents toward children with epilepsy. Materials: This was a prospective study in a tertiary hospital. All parents who had children suffering from epilepsy seen from April 1 ^st 2009 to March 31 ^st 2010 were recruited. Questionnaires were administered to all the parents who attended the neurology clinic with their children diagnosed of epilepsy. Results: A total of 914 neurological patients were seen and treated during the study period. Of these, 280 parents whose children suffered from epilepsy participated in the study. Almost all, 267 (95.36%) parents had heard about epilepsy prior to presentation in the clinic. Some parents thought that epilepsy was contagious and linked with evil spirit/demonic attack. A few of them rejected the word epilepsy and did not think that an epileptic child could achieve much in life. The knowledge about the clinical characteristics and initial procedures to attend a person during a seizure were unscientific. Conclusions: We concluded that more than 90% of parents and caregivers know about epileptic seizures. However, there is a need to disseminate more information to the public about its causes, clinical manifestation, approach to managing a convulsing child, and its outcome. In addition, periodic medical campaigns aimed at educating the public about epilepsy through the media could go a long way in reducing the morbidity and mortality associated with this disorder.

Background and Objectives: The Exstrophy Complex (EC) is a serious malformation of midline abdominal wall. Wide pubis prevents approximating the lateralized rectus muscle and leads to dehiscence and fistula formation. Our aim was to recommend an easier method for abdominal wall closure in the Bladder Exstrophy (BE) complex repair. Materials and Methods: From November 2007 to April 2010, we had three case of Cloacal Exstrophy (CE) and 10 BE, in which early bladder closure and coverage were performed by wide mobilization of bladder and rectus muscle flap closure in the midline without pubic closure. Results: Two cases of CE had only minor wound dehiscence and bladder prolapsed later. One of the 10 BE cases developed vesicocutaneous fistula and the other two had minor wound dehiscence. Conclusions: Our Technique reconstructed the abdominal wall with less morbidity and hospitalization because of tensionless closure.

Primary gastrointestinal angiosarcomas are very rare and those of the small bowel even more rare. We report a case which is the first in the literature from this part of the world. It presented in a 25-year-old woman with multiple dissemination and rapid fatality. Diagnosis was based on histological morphology using Hematoxylin and Eosin (H and E) stains, plus reticulin special stain to outline the vascular nature.

Appendicitis in the elderly is becoming an increasingly frequent clinical encounter due to the increased life expectancy in the human race over the last half-century. Appendicitis in this age group has, therefore, become relatively more common with an atypical presentation that incurs delay in diagnosis with attendant morbidity and mortality. We present a septuagenarian who presented atypically with a rapidly progressing feature of appendicitis that emphasizes the need for early operative intervention. In addition, the patient presented with other comorbidities that could detract from a diagnosis of appendicitis to the unwary.

Abdominal Compartment Syndrome (ACS) is characterized by intra-abdominal hypertension (IAH), elevation and splinting of the diaphragm, high pleural pressure, and poor venous return to the heart, producing low cardiac output and shock which, in turn, results in poor venous return across the capillaries to set in a vicious cycle. Unless the Intra-abdominal pressure is reduced quickly by urgent surgical or medical interventions, death is inevitable. We report a case of ACS resulting from an unrecognized slow but massive intra-abdominal bleeding caused by a ruptured ectopic pregnancy (REP) in an Arab woman. Due to the unusual nature of the presentation of the REP, the diagnosis proved elusive for over a week until the patient succumbed to hypovolemic shock after losing about 4.2 l inside the peritoneal space. The fruitless effort at aggressive fluid resuscitation was at operation found not due to hypovolemia per se but due to IAH causing ACS. The lessons learned from this case emphasize the need for awareness about atypical presentations of REP and the need for quick intervention to terminate the vicious cycle of ACS.