ࡱ> =?,-./0123456789:;<Y bjbj[[ 19 \9 \}Eqll%%%4D-D-D-h 9R$D-c00ZxDbDbDb~b`F/H/H/H/H/H/H/$1I4Zl/%8|l/Db~bN0 DbDb:F/F/b&".Db\J)P2/300c0)`4d4.4%.8l/l/c04l> : Peer-Review Abstracts PEER-REVIEWED ABSTRACTS OF SCIENTIFIC PAPER PRESENTATION AT THE 54th ANNUAL CONFERENCE OF THE WEST AFRICAN COLLEGE OF SURGEONS AT KUMASI, GHANA 24TH 28TH FEBRUARY, 2014. RESUMES VALUS PAR LES PAIRS DE LA RECHERCHE SCIENTIFIQUE PAPIER PRSENTE LA 54E CONFRENCE ANNUELLE DU COLLEGE DES CHIRURGIENS DE L' AFRIQUE DE L'OUEST, KUMASI, GHANA 24 - 28 FVRIER 2014. STRENGTHENING TRAUMA CARE SYSTEMS GLOBALLY AND IN WEST AFRICA: THE ROLE OF INTERNATIONAL COLLABORATIONS Charles Mock Abstract Injuries are a major source of death and disability, causing over 5 million deaths per year globally. In addition to injury prevention, there is a need to strengthen trauma care. The World Health Organization defines a trauma system as all that a country or area has in place for care of the injured, across the spectrum of pre-hospital care, care in hospitals (both acute resuscitation and definitive care), and rehabilitation. Included in this spectrum are adequate data sources so that informed decisions can be made based on reliable information. There is considerable evidence that countries that improve the organization and planning of their trauma systems are able to decrease mortality rates significantly, in an affordable and sustainable fashion. This abstract will review that evidence and discuss examples of good practice in implementing trauma systems. It will also discuss ongoing initiatives to strengthen trauma systems globally through the World Health Organization and the International Association for Trauma Surgery and Intensive Care (IATSIC). Importantly, Mercy Ships aims to ensure that all training programmes are teaching techniques that are appropriate for the surgical needs in Africa. To help achieve this objective, the design and implementation of these programs is performed in collaboration with Ministries of Health, local medical professionals, non-governmental organizations, and corporate partners. One example of this collaboration is the partnership between the Medical and Surgical Skills Institute of Ghana, Johnson and Johnson, and Mercy Ships to implement the Basic Surgical Skills Course in the Republic of Congo for 13medical professionals. Other partnerships include the WHO Safe Surgeries, Save Lives initiative and Lifebox for training in the Safe Surgery Checklist, the Global Clubfoot Initiative for Ponseti casting training, and many others. Partnerships amongst various actors in the health care industry have helped Mercy Ships develop training opportunities that complement the local health systems while aligning with the capacity of the organization. PUBLIC PRIVATE PARTNERSHIP (PPP) IN HEALTHCARE: A CASE-STUDY OF GARKI HOSPITAL, ABUJA, NIGERIA I Wada Address: Garki Hospital, Tafawa Balewa Way, Garki Area III, Abuja Nigeria. Abstract  MERCY SHIP BASIC SURGICAL SKILLLS COURSES FOR WEST AFRICA Michelle Bullington Abstract Background: Garki Hospital Abuja (GHA) is owned by the Federal Capital Territory Administration (FCTA). In May 2007, the FCTA handed over GHA to Nisa Premier Hospital Ltd (NISA) to manage for 15 years under a renewable Concession Agreement. The objectives were: I. To describe the level of new investments, scope of Mercy Ships operates the world's largest non-governmental hospital ship, delivering high quality surgical interventions to local populations. Using this platform, Mercy Ships is also able to provide training opportunities for African medical professionals. This two-pronged approach that includes both direct medical services and training allows the organization to address immediate needs while improving the capacity of the local health care system. The Mercy Ships Education Program includes three categories: individual-based mentoring projects, curriculum-driven courses, and observation opportunities onboard the Africa Mercy. The objective of Mercy Ships Education Program is to improve knowledge, skills, and professional attitude amongst the participants. services, uptake of the services and assess GHA's suitability for postgraduate training. ii. To determine the financial sustainability of the PPP Concession Methods: The Concession Agreement and reports from GHA's clinical and non-clinical performance from May 2007- December 2012 Results: NISA exceeded the level of new investments stipulated in the Concession Agreement by end of year 2. The full scope of clinical departments were up and running by end of year 1, particularly Obstetrics and gynaecology, Paediatrics, Surgery and Family Medicine. The total outpatient encounters were 18,000 and 70,000 for years 1 and 3 respectively. The Departments of Family Medicine and Obstetrics & Gynaecology were accredited for postgraduate training by 75 year 2. The hospital had reached a break-even financial point by year 3. Conclusion: These results show a successful PPP model for GHA managed in conformity with the Concession Agreement. The PPP project is also financially sustainable. THE ROLE OF 'OPERATION HERNIA' IN RELIEVING GLOBAL BURDEN OF SURGICAL DISEASE Oppong F C, Boateng-Duah B, Ohene-Yeboah M, Irwin T, Fawole S, Abantanga F, Kingsnorth A N. SURGERY AND GLOBAL HEALTH. CORRESPONDENCE: Oppong F C, Derriford Road, Plymouth, UK, PL6 8DH UK E-mail:  HYPERLINK "mailto:chrisoppong@gmail.com" \h chrisoppong@gmail.com Abstract Background: The role of surgical conditions as an important component of the global burden of disease has been neglected until recently. 11% of the global disease burden is treatable by surgery. Hernias are common and cause significant disability. The objective of this paper is to highlight the pivotal work done by Operation Hernia to promote recognition of hernias as an essential component of the global burden of surgical disease and to improve access to treatment in low resourced countries. Methods: Operation Hernia is a surgical charity formed in 2005 by Prof Andrew Kingsnorth and Chris Oppong, consultant surgeons in Plymouth, UK. Its aims are: 1.Repair hernias in low resourced countries mesh, 2.Train local surgeons and 3. Spearhead research in affordable polypropylene mesh. A Hernia Centre was established at Takoradi, Ghana. It now has centres in 10 other countries in low resourced countries. Results: The achievements of Operation Hernia: Over 7000 hernias treated with low morbidity and low 12- month recurrence Successful introduction of routine inguinal hernia Mesh repair into Ghana and other low resourced countries as a safe alternative to sutured repair Proven: Inguinal Hernia repair with affordable mesh repair is cost effective Mesh Repair training workshops successfully pioneered in Ghana to train local surgeons. Scientific basis of safety of affordable mesh Research proven quality of affordable mesh Conclusion: Operation Hernia has successfully highlighted hernias as important cause of disability, and the need include in comprehensivehealth plans in low resourced countries. REPAIR OF GROIN HERNIA WITH PROSTHETIC MESH IN OUAGADOUGOU Les cures de hernies de l'aine par prothse Ouagadougou Ouangre E, Zida M, Sanou A, Bonkoungou P G, Zongo N, Kabore E, et al. Zongo N, Kabore E, et al. mail:  HYPERLINK "mailto:ouangredgar@yahoo.fr" \h ouangredgar@yahoo.fr Tel: (00226) 70 70 66 03 Abstract Introduction: Les techniques de rparation prothtiques des hernies de l'aine sont de plus en plus utilises. Objectifs: tudier les cures de hernies de l'aine par prothse Ouagadougou Patients et mthode: Il s'est agi d'une tude transversale descriptive allant du 1er janvier 2008 au 31 dcembre 2012. Ont t inclus dans notre tude tous les patients de plus de 15 ans oprs pour hernie de l'aine par prothse dans quatre centres de sant de la ville de Ouagadougou et ayant un dossier clinique complet. Rsultats: Au total 129 hernies ont t opres dont 26,36% des rcidives, 128 hernies inguinales, 28 hernies bilatrales et une hernie fmorale. La topographie droite reprsentait 59,69%. L'ge moyen des patients tait de 49,59 ans. Le sex- ratio tait de 9,45. Les travailleurs de force reprsentaient 33,33%. La rachi anesthsie a t ralise chez 115 (78,26%) patients. L'intervention a t ralise froid chez 98,26%. L'incision inguinale oblique a t effectue dans 72,09% des cures La technique de Lichtenstein a t pratique dans 96,12% (n=129) et la prothse en polypropylne tait utilise dans 91,47%. La dure moyenne de l'intervention tait de 52,79 minutes. Le sjour moyen hospitalier tait de 1,94 jour. Neuf patients ont prsent des complications locales. Nous avons recueilli 11 sensations de gne rsiduelle aprs un suivi moyen de 22,85 mois. Aucune rcidive n'a t notifie. Conclusion la technique de Lichtenstein est de plus en plus utilise Ouagadougou malgr le cot. Mots cls: hernie, aine, technique de Lichtenstein, Ouagadougou. REPAIR OF GROIN HERNIA WITH PROSTHETIC MESH IN OUAGADOUGOU Abstract Background: Groin hernia repair by using prosthetic mesh are increasingly used, mainly owing to the ease of the operation and because it provides a tension-free. The aim is to study the courses of groin hernia with prosthetic in Ouagadougou. Methods: This was a retrospective, cross-sectional and descriptive study from 1 January 2008 to 31 December 2012.We included patients who received groin hernia repair in four health centers in the city of Ouagadougou. Results: 129 groin hernias were operated with 26.36 % of recurrences, 128 were inguinal, one femoral and 28 bilateral hernias. The right topography represented 59.69 %. The mean age of the operated patients was 49.59 years. The sex ratio was 9.45. Strength workers represented 33.33 % of patients. The spinal anesthesia was performed in 78.26 % of patients, 98.26 % of operations were planned. The oblique inguinal incision was performed in 72.09 % of courses. The Lichtenstein repair was more frequent 96.12 % and polypropylene prosthesis was used in 91.47 %. The mean duration of operation was 52.79 minutes. The mean hospital stay was 1.94 days. Nine patients had early local complications. We received 11 complaints of feeling residual discomfort after a mean follow-up of 22.85 months. No recurrence has been reported. Conclusion: The Lichtenstein repair is the most commonly used in Ouagadougou with satisfactory results despite inadequate patient monitoring. Keywords: Groin hernia, Prosthetic mesh, Lichtenstein repair, Ouagadougou 76 THE INCIDENCE OF STRANGULATED INGUINAL HERNIA IN ADULT MALES IN KUMASI M Ohene-Yeboah Department of Surgery,Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Abstract Background: The complications of untreated inguinal hernias are common surgical emergencies in adult Ghanaian men. The objective is to describe the epidemiology of strangulated inguinal hernia in adult males in Kumasi. Method: From the hospital records the age and sex of all male adult patients treated for strangulated inguinal hernia were recorded at the Komfo Anokye Teaching Hospital, the University Hospital(UH), the Seventh Day Adventist Hospital(SDAH) andthe Kumasi South Hospital (KSH) for the period January 2007 to December 2011 inclusive. The total number of inguinal hernia repairs from all four facilities was also recorded. The annual incidence of strangulated inguinal hernia and the hernia repair rateswereestimatedusingthe 2010 populationdata. Results: In all 592 cases of strangulated inguinal hernia were treated over the five years. The incidence of strangulated inguinal hernia is 0.26%. A total of 2243 inguinal hernia repairs were performed and 26.4 % of these repairs were for strangulation. The total number of inguinal hernia repairs averaged 77.3 repairs per 100 000 adult males per year and the elective repair rate was low at 0.9%. Conclusion: There is the need to increase the low levels of elective repair if inguinal hernia. Keywords: Strangulated inguinal hernia, Incidence, Inguinal hernia repair rates, Adults, Kumasi, Ghana. MESH REPAIR OF INGUINAL HERNIAS CAN BE PERFORMED SAFELY IN RWANDA TO REDUCE BURDEN OF DISEASE. Oppong F C, Nutagengwa A. SURGERY AND GLOBAL HEALTH. ADDRESSS: Derriford Road, Plymouth, UK, PL6 8DH UK, E-mail:  HYPERLINK "mailto:chrisoppong@gmail.com" \h chrisoppong@gmail.com Nyamata Hospital, Rwanda, E-mail:  HYPERLINK "mailto:alfar777@gmail.com" \h alfar777@gmail.com CORRESPONDING AUTHOR: CHRISTIAN OPPONG, Derriford Hospital. Abstract Background: Eleven percent (11%) of the global disease burden is treatable by surgery. Hernias are common and cause significant disability. Estimated burden (prevalence) of hernias in Rwanda is 5.78% This compares with 5.36% in Tanzania, also in East Africa and 3.15% in Ghana in West Africa. Mesh repair of hernias averts significant number of disability adjusted life years (DALY). In low resourced countries high tension, sutured repair is standard because of cost of brand mesh and unavailability of skill. Resultant high recurrence rate increases total cost of treatment of hernias. The objective of study, therefore, is to successfully introduce mesh repair of hernias into Rwandan hospitals as a safe and effective alternative to sutured repair. Methods: In 2012 and 2013, surgeons from Operation Hernia, a UK charity, affiliated to Ghana Hernia Society, performed 54 mesh repair of inguinal hernias at Nyamata and Remera hospitals in Rwanda. All cases were recorded on Operation Hernia database. Results: Fifty-four (54) hernias were repaired in 45 patients. Median age was 56 years. 60% were RIH. Only 27.7% (15cases) were scrotal. 14.8% (8) were recurrent. There were neither deaths nor significant intra-operative complications. Two (2) patients had minor haematomas. At 6 months review, there were no reported septic complications. 12 month review of all 28 patients from 2012 showed no recurrences. Conclusion: For the first time in the history of the Rwandan hospitals, 54 inguinal hernias were repaired with mesh successfully with minimal morbidity and no deaths. Subsequent missions will include training of local surgeons in mesh repair. THE ROLE OF TRAUMA REGISTRIES Laura Cassidy Address: Medical College, Wisconsin, Milwaukee WI, USA Abstract Globally, over the past four decades focus on injury prevention, research and treatment has been increasing. As with any disease the fundamental principles of research and prevention apply to traumatic injury and it cannot be controlled or prevented without a thorough understanding of the aetiology from cause to long term outcomes. Trauma registries are an integral part of a trauma system and can facilitate: Injury Prevention through descriptive epidemiology Development of population specific injury severity scales and stringent evaluation of these scales for reliability and validity. Data to promote research for disaster preparedness. Evaluation of quality of care and quality improvement activities at individual trauma centres and across centres, including trends in care. While trauma registries have been operational in high income countries (HICs) for decades, they are basically nonexistent or rudimentary in low and middle income countries (LMICs), despite having the highest burden of injury. Even where some form of registry exists in some LMICS, they are often entirely paper-based, making data entry and retrieval cumbersome and time consuming. Such registries may be incomplete and the efforts face significant barriers including lack of funding and unfavourable government health policies. Efforts to implement trauma registries in LMICs will be discussed. Collaboration between the existing efforts and implementing lessons learned from HMICs can leverage existing resources and expertise to strive toward a minimum standardized data set in LMICs. These data are essential to convince policy makers about the increasing burden of trauma, mortality and associated long term disabilities. These data would provide a strong advocacy tool, and help in planning control measures, making provisions for unmet capacity needs as well as appropriate allocation of already limited health care funding and resources. THE BURDEN OF ORTHOPAEDIC PRACTICE IN WEST AFRICAN SUB-REGION P I Amaraegbulam Federal teaching Hospital, Abakaliki, Ebonyi State, Nigeria E-mail:  HYPERLINK "mailto:peacify12@gmail.com" \h peacify12@gmail.com Abstract Background: The burden of musculo-skeletal disease in low- and middle- income countries, including Nigeria, is large, growing and neglected. The wide range of musculoskeletal diseases including trauma, infections, congenital anomalies 77 and degenerative diseases are not adequately emphasized, and the knowledge not versatile, even among health workers. The aim of this study is to assess the burden of orthopaedic surgery in West Africa, with the view to making recommendations on adequate care. Methods: Literature search on the topic, personal interviews to health workers and patients, direct observation of the hospitals involved in orthopaedic care. Results: Nigeria has about 500 orthopaedic surgeons, Burkina Faso, Sierra Leone 4 each, and Ghana about 20 and Liberia 2. These orthopods practice mainly in the cities leaving the rural areas inadequately covered. The rural dwellers use the traditional care givers more often, and most times present late to theorthopaedicsurgeonswithcomplications. Thereisadearthof epidemiologicalstudiesontheseconditionsinthecentres. Conclusion: There is a high prevalence of musculoskeletal diseases in West Africa. The number of orthopaedic surgeons who should attend to these is few, with most of them practicing in the cities. Mid-level manpower, including traditional bone setters should be trained to bridge the gap, and health education provided by the orthopods to the populace in order to increase awareness and appropriate health seeking behaviour. CAN ROCURONIUM REPLACE SUXAMETHONIUM FOR TRACHEAL INTUBATIONDURING THE EMERGENCY MANAGEMENT OF PENETRATING EYE INJURY? Agbamu PO1, Menkiti ID1, Desalu I2, Kushimo Ot2, Akinsola FB3 1Department of Anaesthesia, Lagos University Teaching Hospital, 2Department of Anaesthesia, Lagos University Teaching Hospital/College of Medicine University of Lagos, 3Department of Ophthalmology, Lagos University Teaching Hospital/College of Medicine University of Lagos, Lagos, Nigeria. Abstract Background: Suxamethonium causes a rise in intraocular pressure (IOP). Its use for intraocular surgical procedures especially management of the penetrating eye injury is controversial because of the risk of extrusion of vitreous contents. This risk can be avoided by substituting it with rocuronium. The aim of this study was to compare the IOP changes and intubating conditions following the use of both muscle relaxants. Methods: This was a prospective, randomized study in which 70 patients received suxamethonium 1.5mg/kg or rocuronium 0.9mg/kg after induction with thiopentone 5mg/kg. Laryngoscopy was performed after 60 seconds. Measurements of IOP were taken before induction, 1 minute after administration of either muscle relaxant and at 1, 3 and 5 minutes after intubation. Intubating conditions were evaluated using a simple scoring system. Results: Suxamethonium caused a significant rise in IOP throughout the study period (p < 0.005), maximal 1 minute after intubation (p < 0.001). Rocuronium caused a significant fall in IOP 1 minute after administration (p < 0.001) and this remained less than the baseline value in the post intubation period. Intubating conditions in both groups were similar. Conclusion: Rocuronium can replace suxamethonium for tracheal intubation when a rise in IOP is undesirable. Keywords: Suxamethonium, rocuronium, intraocular pressure, penetrating eye injury THE EFFECT OF USE VERSUS NON-USE OF URETHRAL CATHETERIZATION DURING ELECTIVE CAESAREAN SECTION Onwudiwe Elijah N* Ezegwui H U, Dim C C Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital (UNTH) Enugu Nigeria. *Corresponding Author: Dr Onwudiwe Elijah N, Telephone: +2348036777789 E-mail:  HYPERLINK "mailto:belovedijah47@gmail.com" \h belov HYPERLINK "mailto:edijah47@gmail.com" \h edijah47@gmail.com Abstract Background: Peri-operative urinary catheterization during elective caesarean section is practised with the aim of proper visual of the lower uterine segment, minimizing the risk of accidental cystotomy and avoiding postoperative urinary retention. However this practice has been associated with some post operative morbidity like urinary tract infection. The impact of non-catheterization on the peri-operative urinary bladder morbidities during elective caesarean section was determined in Enugu, Nigeria. Methods: A multicentre, randomized controlled trial using 264 term pregnant women who had elective Caesarean section in three centres in Enugu, Nigeria over a period of one year was done.Participants were randomized into catheter and non-catheter group. Result: The incidence of significant bacteriuria was lower in group A (6.8%, 9/132) when compared to the catheter group (12.9%, 17/132) (P=0.10).Urinary retention was observed in 14 participants of the non catheter group. Sixty three women (47.7%) in the catheter group were satisfied with use of catheter while 75% of the non catheter group expressed satisfaction with non catheterization (P<0.001). Conclusion: There was no significant difference in the peri- operative bladder morbidities during elective caesarean section in Enugu, however more patients were satisfied with non catheterization. SYSTEMS STRENGTHENEING FOR IMPROVED HEALTH SERVICES: EFFECTIVE AND EFFICIENT MANAGEMENT OF HEALTH CARE FACILITIES Anthony Nsiah-Asare, Former CEO, Komfo Anokye Teaching Hospital. Correspondence: DR. ANTHONY NSIAH-ASARE, P.O. BOX KS 12378, KUMASI, GHANA TELEPHONE: +233 202022159  HYPERLINK "mailto:ansiahasare@gmail.com" \h EMAIL:ansiahasar HYPERLINK "mailto:e@gmail.com" \h e@gmail.com Abstract Hospitals have been relatively neglected in the debate over Health System Development in developing countries, (Hanson et al (2001). It is clear that efficiency of health care facilities is important and vital to the overall efficiency of any health system. Health care facilities consume the high resources in the health sector of any nation and therefore, efficiency from such a system should generate high gains. Further functioning hospitals have become the hallmark of the overall state of the health system, noting that functional problems at the hospital level may create problems down the entire health system. In the developing world, the state plays a major role in the provision of health services. However, over the years there has been a general collapse of centrally planned economic systems that underscored the poor performance of government services worldwide, (Kaul et al, 1997). Kaul suggests the 78 restructuring of government system such that Policy formulation and Implementation are separated so that as governments move from a concern to do towards a concern to ensure that things are done, managerial focus will be directed towards results, distinguishing between political and managerial responsibilities. This approach ensures that accountability is enhanced by tighter definitions of tasks, measurement of performance, devolution of resource control, strengthening monitoringandclarifyingincentives(Kauletal, 1997). The Ghana Health Sector Reforms which started in 1988 and also addressed the shortcomings in the Hospitals Administration Law, PNDC Law 209, enacted Act 525 of 1996. The Act established the Ghana Health Serviceand Teaching Hospital Boardswhichamong other things provided for related matters including the functions and membership of the Council and Boards, and the managementofinstitutionsinthe Health Service. Traditionally, hospitals have been organized on functional groupings or clinical departments, with functional units supporting the clinical departments (e.g. laboratory, imaging, pharmacy), (Aas,1997). Aas further noted that the closer the decision-making is to the area of activity, the better the flow of information, distribution of workload, avoidance of duplication of work, efficient use of scarce resources and builds the confidence of the staff. Aas (1997 p 104) quotes extensively to show that decentralization leads to productivity, quality and organizational adoption to need and demand. This view is supported by Kaul, (1997), WHO (2000). The health sector reform has been described in various forms mainly because it falls within a continuum that starts from non- market bureaucratic system to a complete market system with a degree of self management responsibility, or 'autonomy'. There are organizational arrangements that characterize hospitals and Newbrander (1993; 1995) and Stover (1991) cited by Collins et al (1999) describe them as Governance, Operations and Management, and Finances. The case of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana that adopted the divisionalised decentralised form of organizational design in 2002 is presented to show the benefits of effective and efficient management of a health facility. These reforms transformed KATH considerably to achieve the Hospital's mandate as a Teaching Hospital. Estimating the Prevalence of Fistulas in a Nationally Representative Survey in Sierra Leone Hiten D Patel, Thaim B Kamara, , Adam L Kushner, Reinou S Groen, a James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD b Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD c College of Medicine and Allied Health Science, Freetown, Sierra Leone d Department of Surgery, Connaught Hospital, Freetown, Sierra Leone e University of Sierra Leone, Freetown, Sierra Leone f Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD g Surgeons OverSeas (SOS), New York, NY h Department of Surgery, Columbia University, New York, NY I Department of Gynaecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD Corresponding Author: Reinou S. Groen, Johns Hopkins Hospital, Department of Gynecology and Obstetrics, 600 North Wolfe Street, Phipps 264, 21287 Baltimore, Maryland, USA E- mail:  HYPERLINK "mailto:rsgroen@hotmail.com" \h rsgroen@hotmail.com or  HYPERLINK "mailto:rgroen1@jhmi.edu" \h rgr HYPERLINK "mailto:oen1@jhmi.edu" \h oen1@jhmi.edu Abstract Objective: To report the prevalence of urinary and fecal incontinence with the barriers to care and associated disability for Women in Sierra Leone. Methods: The study was a cross-sectional two-stage cluster based household survey in Sierra Leone. It included women>14 years of age, randomly accessed in 75 clusters. Surgeons Over Seas Assessment of Surgical need (SOSAS) was administered in Sierra Leone. Data from a verbal head-to-toe examination were analyzed to estimate the prevalence of fistulas based on reporting of urinary and/or fecal incontinence. Main Outcome Measures: The primary outcome measured was self-reported incontinence. Secondary outcomes included barriers to care and disability. Results: Of 1320 women included in the study, 8 cases of incontinence were identified corresponding to a prevalence of 606 fistula's per 100,000 women (95%CI 187-1025) and extrapolating to >10,000 women in Sierra Leone. All cases lived in a rural village (rural rate of 1030 per 100,000 women (95%CI 319-1743)) where transport time to health facilities was longer compared to urban areas (p<0.001), and most (75%) did not seek healthcare attention due to lack of money (67%). Feeling ashamed, difficulty with transportation, and difficulty working were the major disabilities reported. Conclusions: The burden of unrepaired fistulas in Sierra Leone is significant and highlights the urban-rural divide likely affecting the majority of sub-Saharan Africa. Since the most common origin is delay in obstetrical interventions, increased surgical capacity will be necessary in order to prevent and repair these fistulas. Keywords: Fistula, Sierra Leone, Access to care, Survey Abbreviations and Acronyms: LMICs - low and middle income countries; SOSAS - Surgeons OverSeas Assessment of Surgical Need. POLYP PREVALENCE AT COLONOSCOPY AMONG NIGERIANS: A PROSPECTIVE OBSERVATIONAL STUDY Olusegun I. Alatise1, Anthony O. Arigbabu1, Augustine E. Agbakwuru1, Oladejo O. Lawal1, Oluwole Olaniyi Odujoko1, Omolade Adegoke2, Olusegun Ojo2 Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. Department of Morbid Anatomy, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. Corresponding Author: Dr OI Alatise, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile - Ife, Nigeria. Mobile No: +234-803-385-9387.  HYPERLINK "mailto:segunalatishe@yahoo.co.uk" \h E-mail:segunalatishe@yahoo.co.uk Abstract Background: Colorectal polyps, which are generally thought to be forerunners of colorectal malignancies, are believed to be rare among black Africans. This study was aimed at identifying the prevalence, distribution and clinic-pathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria. We also determined the 79 polyp detection rate (PDR), Polyps per colonoscopy (PPC) and adenoma detection rate (ADR). Methods: This study is a prospective observational study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2012. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, histo-pathological characteristics of the polyps. Polyp detection rate, adenoma detection rate and polyps per colonoscopy (PPC) were calculated. Data were analyzed using SPSS version 21. Results: During the study period a total 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2 to 87 years with a median of 57 years. Forty-three (62.3%) patients were 50 years or above and there were 40 (59.7%) males. Thirty three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer and 13 (19.4%) for routine screening. Thirty nine (58.2%) patients had the polyps at the rectosigmoids region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segment. Adenomatous polyps was the most common [28 (47.5%)] histo-pathological finding of which 2 patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (p=0.010). No statistical significance was obtained when the histological diagnosis was compared with sex of the patient(p=0.381) andlocationofthepolyps(p=0.483). Conclusion: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above. Key Words: Polyps, Adenoma, hyperplastic, Inflammatory, Prevalence, Nigeria SELF-INFLICTED GUNSHOT INJURY John Owoade Agboola, Joshua Taiye I Ige Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. E-mail:  HYPERLINK "mailto:owoade14@gmail.com" \h owoade14@gmail.com Abstract Background: Gunshot abdominal injury is a common phenomenon in trauma, either as a lone injury or as part of injury in a poly trauma patient. However, accidental self- inflicted gunshot injury to the abdomen is not common. We hereby present a case report of a patient with accidental self- inflicted gunshot injury. Case Presentation: A 17-year old male patient presented at our surgical emergency with peritonitis. He had accidentally dropped a loaded and corked locally made gun while pursuing game. The gun landed on a ridge in front of him and fired several rounds directly at him. He had sustained bullet wounds to the abdomen, right upper and lower limbs. Findings at surgery revealed multiple perforations of the jejunum and its mesentery. A week later he developed septic arthritis with pus collection in the right knee. X-ray revealed multiple pellets in the right knee. He subsequently had incision and drainage. Conclusion: Many local hunters exist in our communities in Africa but handing over a gun to a teenager could more easily result in such accidental self-inflicted injuries. Documentation of such injuries is necessary to create awareness of the need for caution in the use of local firearms. Early presentation and prompt management saved the patient's life. Keywords: Gunshot injury, Self-inflicted. DIVERTICULAR DISEASE OF THE COLON IN KORLE BU TEACHNG HOSPITAL - A 3-YEAR REVIEW Emmanuel Nachelleh and Rudolph Darko Department of Surgery, University of Ghana Medical School, Korle Bu Abstract Background: Colonic diverticulum: herniation of the mucosa, submucosa through a weak site of the colonic wall. It is symptomatic only in 20% of cases and may present as diverticulitis or bleeding per rectum. A few cases require elective resection to prevent some of the complications when the symptoms are repeated and frequent. It is rare in Africa and Asia but common in USA, Europe and Australia. In the Western countries, it is commoner at the sigmoid (left) while in Asia the right colon is most commonly involved. The aim of the study is to ascertain whether the prevalence of diverticular disease has changed in the same hospital. The study also sets to ascertain the pattern of the diverticuli and the age spread of the disease Methods: This is a cross-sectional study. It is a combined retrospective and prospective study performed at the endoscopy room identifying all patients who were noticed to have diverticuli of the colon during lower gastrointestinal endoscopy. The patients seen from October 2010 to September 2012 were recorded retrospectively while those seen from October 2012 to September 2013 were recorded prospectively. Inclusion criteria: only those who had complete or near complete colonoscopy were included in the study. Method of preparation: Patients had an overnight fast and were made to take 2 sachet of Polyethylene glycol mixed in 1 litre of warm water. The patients took the first dose between 3 and 5 pm the night before and the remaining was taken at about 3 AM on the morning of the procedure. This invariably purged them and made the colon clean for good viewing, Results: A total of 1919 lower gastrointestinal endoscopies were performed. Out of this 145 were found to have diverticuli (7.6%) with a male female ratio of 1.6:1 This compares with 14 cases recorded over a similar period in 1974-76 and 1976 in 1987-2000 37 cases seen in 1997-2000. The commonest indication for the colonoscopy was bleeding per rectum (62%) and 15% of patients had the colonoscopy for change in bowel habits while 8% of patients had the colonoscopy for screening. Location of the diverticuli: Forty two percent had the diverticuli in the left colon. CONCLUSION: Most patients required the colonoscopy for bleeding but it would be most helpful if patient would undergo screening for so that most cancers would be diagnosed early. 80  SHAPE \* MERGEFORMAT  SURGICAL TREATMENT OF ENTEROCUTANEOUS FISTULA: OUTCOMES OF A NINE-YEAR EXPERIENCE. Adamu Ahmed, Ukwenya A Yahaya, Enesi Peter. Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria Correspondence: Dr Adamu Ahmed, Department of Surgery Ahmadu Bello University Teaching Hospital Zaria, Nigeria Email:mrahmed1010 @yahoo.com Abstract Background: The management of enterocutaneous fistula (ECF) is very challenging and is often associated with significant morbidity and mortality. In poor resource settings such as ours, while appropriate supportive facilities are limited the patients present in advanced stage of malnutrition and sepsis. The objective of this study was to present our experience on the postoperative outcomes, morbidity and mortality following surgical management of ECF. Methods: This is a prospective study of patients who presented to our tertiary care referral centre from 2005 to 2013 and subsequently underwent definitive surgical treatment of ECF. Management strategy consisted of controlling sepsis, optimizing nutritional state, wound care, defining fistulas anatomy, timing of surgery and surgical strategy. Following diagnosis of ECF imaging studies, haematological, biochemical and microbiological investigations were carried out. Appropriate resuscitation and stoma care were also instituted. The primary outcome measures were postoperative fistula recurrence and mortality, assessed by multiple logistic regression analysis. Results: A total of 106 patients with ECF were treated. In 41(38.7%) patients the fistulas closed spontaneously. Of the remaining 65 (61.3%) that required operative closure of their fistulas, 39 (60%) were males. Their age ranged from 18-77 years, mean of 31 7.4 SD. 54(83%). The patients were referred from other institutions. Most (78.5%) fistulas occurred postoperatively. Restorative operations for fistula closure were performed after a median of 13weeks (range 1-38) and were successful in 57 (87.7%) patients. Mortality was 10.8%. Abdominal wall defect, preoperative serum albumin were significantly associated with fistula recurrence(p< 0.001) and mortality(p< 0.005) Conclusion: A multi-disciplinary approach focusing on fluid and electrolytes replacement, nutritional rehabilitation, sepsis control and timed surgical intervention is necessary to reduce morbidity and mortality in patients with ECF. The high rate of ECF resulting from anastomotic break in patients referred from peripheral hospitals calls for surgical skills acquisition programmes in our sub-region. SISTER MARY JOSEPH NODULE: MANAGEMENT IN A UNIVERSITY TEACHING HOSPITAL IN NORTHERN NIGERIA Adamu Ahmed, Ukwenya A Yahaya. Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. CORRESPONDENCE: Dr Adamu Ahmed, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Email:  HYPERLINK "mailto:mrahmed1010@yahoo.com" \h mrahmed1010@yahoo.com Abstract Background: Sister Mary Joseph nodule (SMJN), a metastasis of visceral malignancy to the umbilicus is very rare and is encountered in 1-3% of intra-abdominal and pelvic malignancies. It often represents advanced malignancy with dismal prognosis. In this study we present the clinico- pathological features and treatment outcome of this condition in our environment and highlight challenges associated with the care of these patients. Methods: This was a retrospective study of histologically confirmed cases of Sister Mary Joseph's nodules seen at the Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria between January 2003 and December 2013. Following examination, imaging, biochemical, immunological and other appropriate investigations were carried out to establish the primary disease. Patients' treatment was directed at achieving the best palliation. Data collected were analyzed using descriptive statistics. Results: There were 25 patients with SMJN, 15 (60%) were males while 10 (40%) were females. Their ages range from 17- 82 years; median 48years. The nodules sizes ranged from 2-8 cm, mean 3.2cm. In 14 (56%) patients there was an ulcerated umbilical nodule >5cm at presentation. The stomach was the most common site of origin (60%). 15 (60%) patients had previous diagnosis of malignancy before they presented with SMJN. The primary tumour could not be determined in 3(12%) patients. As the disease was advanced in all patients, only palliative treatment was offered. 16 (64%) patients had complete excision of their nodules which recurred in 4 after 3- 17 months. 4 (16%) patients died in the hospital. Overall median survival was 7 months (ranged 2-19months). Conclusion: SMJN represents manifestation of a variety of advanced intra-abdominal malignancies. Although patient's survival is very short leading to a poor outcome, local treatment of the nodule is associated with improved quality of life. Detection of the primary cancer at an early stage may improve the prognosis. ERYTHROCYTE SEDIMENTATION RATE (ESR) AND C- REACTIVE PROTEIN (CRP) LEVELS IN BREAST CANCER PATIENTS IN BENIN CITY, NIGERIA Eboreime o1, Idemudia J.O2, Atoe K2. DEPARTMENT OF SURGERY, CENTRAL HOSPITAL, BENIN CITY, NIGERIA. DEPARTMENT OF CHEMICAL PATHOLOGY, UNIVERSITY OF BENIN TEACHING HOSPITAL BENIN CITY, NIGERIA. Abstract Background: Breast cancer is the most common type of cancer in women and the leading cause of cancer-related death worldwide. Inflammation has been shown to play a role in the pathogenesis of breast cancer. A high ESR has been found to correlate with prognosis of breast cancer and other types of cancer. Serum CRP has been shown to parallel carcinogenesis, possibly as an expression of the host defense reaction or as paraneoplastic syndrome. Methods: This study was to determine the level of some systemic inflammation markers (ESR & CRP) in patients with breast cancer compared to those without the disease. Venous blood was obtained from participants. Erythrocyte Sedimentation Rate (ESR) and C-Reactive Proteins (CRP) levels were determined using standardized laboratory methods. Results: Results showed a statistically significant increase (P <0.05) in both ESR and CRP levels of patients with breast cancer compared with the control. There was also a significant positive correlation (P<0.001) between ESR and CRP in the study population. Conclusion: These findings suggest that inflammation may be a risk factor for the development of breast cancer. This association perhaps has clinical significance of prognostic value. 81 SERUM MAGNESIUM LEVELS IN WOMEN WITH BREAST CANCER IN BENIN CITY, NIGERIA Atoe K1, Idemudia J.O1, Eboreime O2. DEPARTMENT OF CHEMICAL PATHOLOGY, UNIVERSITY OF BENIN TEACHING HOSPITAL BENIN CITY, NIGERIA. DEPARTMENT OF SURGERY, CENTRAL HOSPITAL, BENIN CITY, NIGERIA. Abstract Background: The aim of this study was to compare the serum magnesium levels of patients with breast cancer and apparently healthy people without the disease. Methods: This is a cross-sectional prospective study carried out at the Department of Surgery, Central Hospital, Benin City and Department of Chemical Pathology, University of Benin Teaching Hospital Benin city, Nigeria, between July, 2011 and October 2012. Methodology: A total of 60 female participants from Central Hospital, Benin City, Nigeria were recruited for this study. 30 of the women (50%) had breast cancer and 30 women (50%) without the disease served as control. Venous blood was obtained from participants and serum magnesium level was determined using standardized laboratory methods. Results: The results showed a statistically significant reduction in serum magnesium level of patients with breast cancer compared with those without the disease. Conclusion: We demonstrated from this present study that the participants with breast cancer have reduced serum magnesium level compared to those without the disease (control) and it is advisable to cautiously add magnesium as an adjuvant therapy in the management of breast cancer. Key words: Seru m magn esiu m, b reast can cer, hypomagnesaemia, metabolism, adjuvant therapy. TRIPLE PATHOLOGY IN A PATIENT WITH ACUTE ABDOMEN John O Agboola, Joshua Taiye Itunuoluwa Ige. Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria Abstract Background: Gastric perforation, acute pancreatitis and acute mesenteric ischaemia are surgical emergencies with grave consequences. Patients presenting with any of these pathology alone has a significant risk of death (12%, 30% & 60% mortality rates respectively). There are few reported cases of patients presenting with dual pathology. To our knowledge, triple pathology is a rare occurrence. Case Presentation: A 76-year old known hypertensive female patient presented to our surgical emergency unit in hypovolemic shock. She had 5 days history of lower abdominal pain, gradual abdominal distension and 3 days of absolute constipation. With a diagnosis of sigmoid volvulus with possible gangrenous bowel, she was promptly resuscitated and subsequently had laparotomy. Findings at surgery revealed patchy gangrene of the small bowel, the ceacum and the corresponding mesentery, gross fatty necrosis involving the greater omentum and small bowel mesentery and 1cm perforation in the gastric antrum. Histology revealed ischemic necrosis of the resected bowel. The patient had an eventful postoperative period, gradually improved andwasfinallydischarged. Conclusion: Prompt surgical Intervention maximized the chances of survival in this elderly patient. The rare combination of these pathologies in the patient is quite difficult to explain. Possible hypothesis would be gastric perforation followed by acute pancreatitis from continued use of antihypertensives and subsequent ischaemic infarction of the small bowel from hypovolemic shock. Keywords: Triple pathology, Acuteabdomen. PRIMARY ACTINOMYCOSIS OF THE BREAST IN A PRE- MENOPAUSAL WOMAN Abdulrahman G O Jnr, Gateley C A. Department of Surgery, Royal Gwent Hospital, Newport NP20 2UB, United Kingdom Abstract Background: Actinomycosis of the breast is a rare disease which may mimic malignancy in presentation. Clinical presentation may make it difficult to distinguish primary actinomycosis from mastitis and inflammatory carcinoma. Case report: A 22-year-old lady presented with a 2-week history of right breast pain and greenish discharge through her nipple piercing. She was initially started on flucloxacillin by her GP 3 days prior to presenting to us with no improvement. Physical examination revealed an area of erythema in the upper inner quadrant of the right breast with an abscess at the edge of the areola. Histological examination of the aspirate isolated Actinomyces turicensis and Peptoniphilus harei. Conclusion: Actinomycosis of the breast is rare and the species, Actinomyces turicensis, is even rarer. It is a difficult organism to treat due to its relative indolent course with potential scarring and disruption of local tissue. However, surgical intervention could be avoided with an intensive course of high-dose IV antibiotics and prolonged oral antibiotics afterwards. MEATOPLASTY: NEW TECHNIQUE FOR ENLARGING THE EXTERNAL AUDITORY MEATUS. Anthony O. Owa, R.M. Ogadako. Broomfield Hospital U.K. Lagos State UniversityTeaching Hospital and Queen's Hospital, U.K. Abstract An adequately-sized external auditory is an essential step in canal wall mastoidectomy. The cavity needs to be easily examined in the clinic and adequately ventilated in order to prevent a recurrence of disease. Having being familiar with the Korners. Fisch and Portmans techniques that had the disadvantages of either having a cosmetically unappealing meatus or meatal re-stenosis, the senior author has developed a different meatoplasty technique which he has been using over the last 18 months. He describes the technique and demonstrates a video of the procedure and gives the results of his technique since its inception. Methods: The record of all records of patients that had the modified meatoplasty were collated. 15 patients were identified. VideoTechnique: The technique is demonstrated in the video, however, the main parts of the technique incorporate endaural and conchal incisions. The resultant end-aural incision leaves the tragus exposed, which is closed with vicryl sutures. A large pieceofconchalcartilageistheremovedwiththewoundclosed loosely leaving the anterior flap and adjoining skin free to be rotatedintothecavity. 82 Results: All external auditory canal were adequately sized, with no stenosis or unsightly scar formation. Conclusion: The technique is a simple and effective way to maintain an adequately sized and cosmetically acceptable external auditory meatus SURGICAL MANAGEMENT OF SUPERIOR CANAL DEHISCENCE SYNDROME USING AUTOLOGOUS MATERIALS- HOW I DO IT. Anthony O.Owa, Rhiyoma M.Ogadako, Rhiyoma M.Ogadak, Josselyne Tedajo Corresponding Author: Anthony O Owa, Queen's Hospital, Barking, Havering and Redbridge University Teaching Hospital NHS Trust, Romford, U.K (Currently on sabbatical at the ENT Department, Lagos State University Teaching Hospital).  HYPERLINK "mailto:owatony@gmail.com" \h owaton HYPERLINK "mailto:y@gmail.com" \h y@gmail.com Abstract Superior canal dehiscence Syndrome is a clinical syndrome characterised by sound or pressure induced vertigo associated with a dehiscence of the superior semi-circular canal. Diagnosis is usually made with a high resolution CT scans associated with the above clinical symptoms in addition to other clinical signs and tests including a lowered VEMP on side of lesion. Most patients can be managed conservatively others with debilitating symptoms are managed surgically. The approaches are either trans-mastoid or middle fossa approach preferred by the senior author. The canal may either be plugged or resurfaced. We present our experience using autologous materials with a video illustration of the technique. Methods: Patients with Superior canal dehiscence syndrome seen in the unit over a 10year period were reviewed. Four patients required surgery using the middle fossa approach resurfacing with autologous material utilising a 5 layer closure (video presentation). Results: Follow up ranged between 2 and 8 years. No patients showed any change in their hearing and remain symptom-free. Conclusion: Middle fossa approach resurfacing the tegmen with autologous material using 5 layer closure of the defect is an effective technique with a low complication rate. LE TRAITEMENT CHIRURGICAL DU SYNDROME DU CANAL SEMI CIRCULAIRE ANTERIEUR PAR L'UTILISATION DE MATERIEL AUTOLOGUE. COMMENT JE LE FAIS? Le syndrome du canal semi circulaire anterieur est caracterise par des vertiges induits par l'exposition aux sons ou a des variations de pression. Ce phenomene est lie a l'absence de couverture osseuse du canal semi- circulaire anterieur. Le diagnostic est etablie grace a l' utilisation de la tomodensitometrie de haute resolution , l'addition d'autres signes cliniques et de tests notamment une baisse du potentiel voqu otolithique du cote de la lesion.La pluspart des patients peuvent tre traites de facon conservative cependant ceux souffrant de symptoms invalidants sont prises en charge chirurgicalement. Les approches se font soit par la voie transmastoidienne ou par la fosse cerebrale moyenne .Cette derrire approche est la voie preferee de l'auteur. Le canal semi circulaire est soit colmate ou recouvert. Nous presentons notre experience de l'utilisation de materiel autologue, avec une video a l' appui. La Methodologie: Revue des patients souffrants du syndrome du canal semi circulaire anterieur sur une periode de 10 ans. 4 patients ont necessite l'utilisation de l' approche par la fosse cerebrale moyenne et la couverture en 5 epaisseurs avec du materiel autologue . (presentations sous forme de video) Resultats: La surveillance a ete mene sur une periode de 2 a 8 ans , en moyenne 5 ans. L'audition de tous les patients est restee inchangee, et tous sont restes aymptomatiques aprs l'intervention. Le colmatage de la fosse cerebrale moyenne avec le materiel autologue et l' utilisation de 5 epaisseurs est une technique efficace avec un faible taux de complications . SEVERITY OF SNORING AMONG HEALTHY ADULTS IN SOUTH WEST NIGERIA Ogunkeyede S A1, Fasunla A J1, Arulogun. O S2, Lasisi. O A1 Department of Otorhinolaryngology University College Hospital Ibadan1, Department of Health education, Faculty of Public Health College of Medicine, University of Ibadan2 Correspondence: OGUNKEYEDE S.A (segunkeyede @yahoo.com) Abstract Background: Snoring results from vibrations in the soft palate and other lax tissues of the throat due to turbulent air flow with pharyngeal hypotonia during sleep. Snoring can be a sign of sleep apnea. This study aimed to determine the severity of snoring among apparently healthy adults. Methods: This was a community based cross-sectional study of randomly selected participants. An interviewer assisted structured questionnaire was administered to all the participants. The questionnaire assessed participants' socio- demography, sleep duration, snoring and daytime sleepiness. The nose, oral cavity, oropharyngeal and neck examination was done to determine any structural abnormality that may contribute to upper airway obstruction. Statistical analysis of the data was done using Statistical package for social sciences (SPSS) version 16, statistical significance was set at p < 0.05. Results: There were 408 participants, 202(49.5%) males and 206(50.5%) females. The age range was between 18 and 82 years (mean age = 37.0 years 15.23). Snoring was encountered in 191(46.8%) participants. The prevalence of daytime sleepiness was 27.7%. Severities of snoring increase with increase in tonsillar size, Mallampati score and age. There was association between the severity of snoring and daytime sleepiness (p < 0.0001). Conclusion: Severity of snoring among apparently healthy adults in Nigeria is associated with many factors and this was higher among the habitual snorers. There is a need for more awareness about this condition in order to control factors associated with snoring. Keywords: Habitual snoring, day-time sleepiness, Epworth sleepiness scale, healthy adult and severity of snoring. MANAGEMENT OF ADULT CHRONIC SUPPURATIVE OTITIS MEDIA IN A RESOURCE POOR COUNTRY L O Onotai, OC Mbalaso Department of ENT Surgery UPTH, Port Harcourt, Nigeria. Corresponding author: Onotai L.O Email  HYPERLINK "mailto:onotailuckinx@yahoo.co.uk" \h onotailuckinx@yahoo.co.uk Abstract Background: Chronic Suppurative Otitis Media (CSOM) cuts across all age groups and its management has been revolutionized by the use of microscopes and other modern equipments. Prompt diagnosis and appropriate management is the key to good clinical recovery. This study determined the clinical profile of adult CSOM in Port Harcourt Nigeria and highlighted its management challenges. 83 Methods: This was a retrospective study of adult patients who presented to the department of Ear Nose and Throat (ENT) surgery of the UPTH, Port Harcourt from January 2002 to December 2012. The patient's data were retrieved from the clinic registers and patients' case notes. Demographic data, clinical presentation, predisposing conditions, aetiological factors, site of tympanic membrane perforation, affected ear, treatment modalities, complications of treatment and outcome of management were recorded and analyzed. Results: Eight hundred and thirty-six patients were found to h a v e C S O M . T h e s e c o n s t i t u t e d 1 2 . 8 % o f a l l otorhinolaryngological cases seen within the study period. There were 404 males and 432 females (male: female ratio of 1.0:1.1). Age range was 18 to 94 years, mean = 38.8 +/- 10.4 years. Age group 18-28 years has the highest (n=412) number of cases. Bilateral CSOM accounted for the highest number (n=250) of cases. Perforation was found more on the antero inferior aspect of the tympanic membrane and the commonest etiological factor was trauma and particularly among the elderly the condition was carried over from childhood. The commonest modeoftreatmentwasconservativemedicaltreatment. Conclusion: This study highlighted our experience in the management of adult CSOM in our setting. The commonest aetiological factor was trauma and the predominant mode of treatment was conservative medical treatment. Keywords: Chronic Suppurative Otitis Media, tubotympanic disease, conservative medical treatment, tympanic membrane perforation, Otorrhea. UNE GESTION DES ADULTES PURULENCE CHRONIQUE OTITE MOYENNE UNE RESSOURCE PAYS PAUVRES. RSUM Contexte: purulence chronique otite moyenne (OMCS) touche tous les groupes d'ge et de sa gestion a t rvolutionn par l'utilisation de microscopes et d'autres quipements modernes. Un diagnostic rapide et une gestion approprie est la cl d'une bonne gurison clinique. Cette tude a dtermin le profil clinique de OMCS adulte Port Harcourt au Nigeria et a soulign les dfis de gestion. Patients et mthodes : Il s'agissait d'une tude rtrospective des patients adultes qui ont prsent au ministre des Oto- rhino -laryngologie (ORL) Chirurgie de la UPTH, Port Harcourt partir de Janvier 2002 to Dcembre 2012. Les donnes du patient ont t rcupres partir des registres de la clinique et les cas les notes de patients. Les donnes dmographiques, la prsentation clinique, facteurs prdisposant, les facteurs tiologiques, le site de perforation tympanique, oreille affecte, les modalits de traitement, les complications du traitement et des rsultats de gestion ont t enregistrs et analyss . Rsultats : Huit cent trente-six patients ont t trouvs avoir OMCS. Ces constituaient 12,8% de tous les cas ORL vu dans la priode de l'tude . Il y avait 404 hommes et 432 femmes ( ratio hommes: femmes de 1,0:1,1 ) . Tranche d'ge tait de 18 94 ans , moyenne = 38,8 + / - 10,4 annes . Tranche d'ge 18-28 ans a le nombre le plus lev ( n = 412 ) des cas. OMCS bilatral a reprsent le plus grand nombre ( n = 250 ) des cas. Perforation a t trouv plus sur l' aspect antro infrieure de la membrane tympanique et le facteur tiologique frquente tait traumatisme et en particulier chez les personnes ges de l'tat a t effectue ds l'enfance . Le mode frquente du traitement tait un traitement mdical conservateur. Conclusion: Cette tude a mis en vidence notre exprience dans la gestion des OMCS adulte dans notre milieu .Le facteur tiologique frquente tait traumatisme et le mode prdominant de traitement tait un traitement mdical conservateur. MOTS CLES: purulence chronique otite moyenne , la maladie tubotympanic , traitement mdical conservateur perforation tympanique , otorrhe . LARYNGOLOGIC SURGERIES: OUR FIVE YEARS' EXPERIENCE IN PORT HARCOURT, NIGERIA L. O. Onotai, Mbalaso OC Department of ENT Surgery UPTH, Port Harcourt, Nigeria. Corresponding author Onotai L.O Email  HYPERLINK "mailto:onotailuckinx@yahoo.co.uk" \h onotailuckinx@yahoo.co.uk Abstract Background: Several patients with otolaryngological diseases more often than not present as emergency to the otolaryngologists as a result of laryngologic diseases that require surgical interventions. This study was conducted to determine the pattern of laryngologic surgeries in Port Harcourt, Nigeria. It will also evaluate the outcome of the surgical management of these patients. Methods: This was a retrospective study of patients who had laryngologic surgeries both in the department of Ear Nose and Throat (ENT) surgery of the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt and Rex Medical Centre in Port Harcourt from January 2008 to January 2013. The patient's data were retrieved from the theatre and clinic registers. The patients' case notes were used to augment the data. Demographic data, clinical presentations, types of laryngologic surgeries, indication for surgeries, outcome of surgeries and complications were recorded and analyzed. Results: One hundred and forty six patients had laryngologic surgeries during the study period. There were 81 males and 65 females (male: female ratio of 1.2:1.0). Age range was 2 months to 76 years, mean = 16.4 +/- 12.2 years. Age group 0- 15 years has the highest (n=58) number of surgeries. The commonest laryngologic surgery done was direct laryngoscopy + removal of foreign bodies. This was followed by tracheostomy. The commonest indication for surgery was upper airway obstruction due to foreign bodies' lodgement in the larynx. The commonest complication encountered in our series was post decannulation airway obstruction in some patients who had tracheostomy.Total laryngectomy was the least in our series. Conclusion: This study highlighted our experience with laryngologic surgeries as seen in Port Harcourt, Nigeria. Direct laryngoscopy and tracheostomy were the commonest laryngologic surgeries encountered in our series. Public enlightenment campaign and prompt diagnosis of foreign bodies in the larynx will help reduce the indications for laryngologic surgeries in our environment. KEY WORDS: Laryngologic surgeries, direct lanryngoscopy, tracheostomy, upper airway obstruction, total laryngectomy. LARYNGOLOGIQUE CHIRURGIES: NOS CINQ ANS D'EXPERIENCE DANS PORT HARCOURT, NIGERIA RSUM Contexte: Plusieurs patients atteints de maladies ORL le plus souvent prsente comme urgence pour les ORL la suite de maladies laryngologique qui ncessitent des interventions chirurgicales. Cette tude a t mene afin de dterminer le modle de chirurgies laryngologique Port Harcourt, Nigeria. Il sera galement d'valuer le rsultat de la prise en charge chirurgicale de ces patients. Patients et mthodes: Il s'agissait d'une tude rtrospective de patients ayant eu des chirurgies laryngologique fois dans le dpartement de Oto-rhino -laryngologie (ORL) Chirurgie de l'Universit de l'hpital universitaire de Port Harcourt (UPTH) , Port Harcourtetlecentremdical Rex Port Harcourtde Janvier 2008 to Janvier 2013. Les donnes du patient ont t extraites 84 du thtre et des registres de la clinique . Cas les notes les patients de ont t utiliss pour complter les donnes . Les donnes dmographiques, des prsentations cliniques , types de chirurgies de laryngologique , indication pour les chirurgies , les rsultats des chirurgies et les complications ont t enregistres etanalyses. Rsultats: Cent quarante six patients ont eu des chirurgies laryngologique au cours de la priode d'tude . Il y avait 81 hommes et 65 femmes ( ratio hommes: femmes de 1,2:1,0 ) . Tranche d'ge tait de 2 mois 76 ans moyenne = 16,4 + / - 12,2 annes Groupe d'ge 0-15 ans a le plus haut ( n = 58 ) le nombre de chirurgies . La chirurgie laryngologique frquente tait fait laryngoscopie directe + enlvement des corps trangers. Ceci a t suivi par une trachotomie. La plus frquente indication opratoire tait une obstruction des voies ariennes suprieures en raison de la dpt de corps trangers dans le larynx. La complication la plus frquente rencontre dans notre srie a t post dcanulation obstruction des voies respiratoires chez certains patients qui ont eu une trachotomie. Laryngectomietotaleestlemoinsdansnotresrie Conclusion: Cette tude a mis en vidence notre exprience avec les chirurgies laryngologique comme vu Port Harcourt, Nigeria. Laryngoscopie directe et la trachotomie ont t les plus frquentes chirurgies. laryngologique rencontres dans notre srie. Campagne de sensibilisation publique et de diagnostic rapide de corps trangers dans le larynx aideront rduire les indications pour la chirurgie laryngologique dans notre environnement. MOTS CLS: chirurgies laryngologique, lanryngoscopy directe , trachotomie , l'obstruction des voies ariennes suprieures , laryngectomie totale . A SURVEY OF PAEDIATRIC OTOLARYNGOLOGIC SURGERIES IN A NIGERIAN UNIVERSITY TEACHING HOSPITAL. L O Onotai, Ude AE. Department of ENT Surgery UPTH, Port Harcourt, Nigeria. Corresponding author Onotai L.O Email  HYPERLINK "mailto:onotailuckinx@yahoo.co.uk" \h onotailuckinx@yahoo.co.uk Abstract Background: In our environment the paediatric population constitutes a large number of our otolaryngologic surgical patients. This study therefore determined the pattern and management outcomes of paediatric otolaryngologic surgeries in the Universityof Port Harcourt Teaching Hospital(UPTH). Methods: This was a retrospective study of paediatric patients who had otolaryngologic surgeries in the department of Ear Nose and Throat (ENT) surgery of the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt from January 2000 to December 2012. The patient's data were retrieved from the theatre and clinic registers. The patients' case notes were used to augment the data. Demographic data, clinical presentations, types of otolaryngologic surgeries, indication for surgeries, outcome of surgeries and complications were recorded and analyzed. Results: Four hundred and ninety five patients had otolaryngologic surgeries during the study period. There were 261 males and 234 females (male: female ratio of 1.1:1.0). Age range was 5 days to 16 years, mean= 9.4 +/- 2.6 years. Age group 2-4 years has the highest (n=180) number of surgeries. The commonest otolaryngologic surgery done was adenotonsillectomy. This was followed by direct laryngoscopy and tracheostomy.. The commonest indication for surgery was obstructive sleep apnoea followed by upper airway obstruction due to foreign bodies' lodgement in the larynx. Mortality was recorded in 5 cases. Conclusion: This study determined the pattern of paediatricotolaryngologic surgeriesin UPTH, Port Harcourt, Nigeria. Thetypesandfactorsthatinfluencetheoutcomeofthese surgeries are critical in policy formulation that can help improve healthcareservicesdeliverytothepaediatricpopulation. KEY WORDS: Otolaryngologic surgeries, Adenotonsillectomy, Directlanryngoscopy, Tracheostomy, Upperairwayobstruction. UNE ENQUTE DE PEDIATRIE CHIRURGIE ORL DANS UN HPITAL DU NIGERIA ENSEIGNEMENT UNIVERSITAIRE RSUM Contexte: Dans notre environnement de la population pdiatrique constitue un grand nombre de nos patients en chirurgie ORL. Cette tude a donc dtermin les motifs et la gestion des rsultats des interventions chirurgicales ORL pdiatrique l'Hpital universitaire de l'enseignement Port Harcourt ( UPTH ) . Patients et mthodes: Il s'agissait d'une tude rtrospective de patients pdiatriques qui ont eu des chirurgies ORL dans le dpartement de Oto-rhino -laryngologie (ORL) Chirurgie de l'Universit de l'hpital universitaire de Port Harcourt (UPTH), Port Harcourt de Janvier 2000 Dcembre 2012. Les donnes du patient ont t extraites du thtre et des registres de la clinique. Cas les notes les patients de ont t utiliss pour complter les donnes . Les donnes dmographiques, des prsentations cliniques, les types de chirurgies ORL, indication pour les chirurgies, les rsultats des chirurgies et les complications ont t enregistres et analyses. Rsultats: Quatre cent quatre-vingt -cinq patients ont eu des chirurgies ORL au cours de la priode d'tude. Il y avait 261 hommes et 234 femmes (ratio hommes: femmes de 1,1:1,0 ). Tranche d'ge tait de 5 jours 16 ans, moyenne = 9,4 + / - 2,6 ans. Tranche d'ge 2-4 ans, a le nombre le plus lev (n = 180) des chirurgies. La plus frquente chirurgie ORL fait tait une adno-amygdalectomie. Elle a t suivie par laryngoscopie directe et trachotomie. Laplusfrquente indicationopratoire tait apne obstructive du sommeil suivie par obstruction des voies ariennes suprieures en raison de la dpt de corps trangers dans le larynx. La mortalit a t enregistre dans les cinqcas. Conclusion: Cette tude a dtermin le modle de chirurgies ORL pdiatrique dans UPTH, Port Harcourt, Nigeria. Les types et les facteurs qui influent sur le rsultat de ces chirurgies sont essentiels dans la formulation des politiques qui peuvent aider amliorer la prestation des services de soins de sant la population pdiatrique. MOTS CLS: cabinets ORL, adno-amygdalectomie, lanryngoscopydirect,trachotomie, l'obstruction des voies ariennes suprieures . ENDOSCOPIC EAR SURGERY - FAD OR USEFUL TOOL FOR MIDDLE EAR SURGERY? Anthony Owa, Josselyn Tedadjo Abstract Objective: The author chronicles his experience of endoscopic ear surgery from April 2013 when he started performing middle ear surgery using an endoscope rather than a microscope. He details his experience and gives advice on how to eliminatepotential pitfalls. Method: All otology cases operated on endoscopically were 85 evaluated and compared with the previous cases done in terms of results, recurrence duration of surgery. Results: 52 cases operated on to date. Results of surgery are no worse than more traditional microsurgical approaches. Operation time was shorter. Endoscopic revision canal wall down mastoidectomy Endoscopic stapedotomy Results: There were a total of forty-three cases. It was deemed too early to determine recurrence rate however the results of hearing reconstruction or graft failure rates were similar. The significant difference was in duration of surgery Conclusion: Endoscopic middle ear surgery is feasible in most middle ear surgical procedures and selective neuro-otological procedures. Surgery is faster and involves less tissue damage and faster recovery from surgery. It was not possible with the current set of instruments to use the endoscope exclusively to deal with extensive cholesteatoma beyond the antrum of the mastoid. Under these circumstances it is probably best to combine its use with an operating microscope.The scope of surgery is limited by equipment design and skill of the surgeon. The author did not experience a learning curve probably as a result of previous experience using an endoscope for rhinological procedures. The advantage of better depth perception and having two hands free was outweighed by the improved view of vital anatomy including the ability to see around corners without the need to remove or damage tissue for improved view and access. Introduction of better instruments including otologic burrs and 3D monitors, relatively cheaper cost and faster set up for surgery may further tip the balance in favour of en SPIROMETRIC EVALUATION OF PATIENTS WITH CLINICALLY DIAGNOSED ALLERGIC RHINOSINUSITIS IN KANO Dr Abdul Razak Ajiya Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria. Email:  HYPERLINK "mailto:ajiyaabdulrazak@yahoo.com" \h ajiyaabdulrazak@yahoo.com Abstract Objective: Allergic rhino-sinusitis is not an uncommon disease and its relationship with asthma has been well documented. Both allergic rhinosinusitis and asthma are systemic inflammatory conditions and are often co-morbidities. However, there is paucity of literature in sub-Saharan Africa on the baseline lung function of patients with allergic rhino- sinusitis. The aim of the study was to determine the lung function status of patients with allergic rhino sinusitis in Kano. Methods: All consecutive patients seen in the ear, nose and throat clinic of Aminu Kano Teaching Hospital with a clinical diagnosis of allergic rhino sinusitis were recruited. Their clinical symptoms were scored using the allergic rhino sinusitis symptom score. Subsequently, the patients had spirometric analysis done, and the data obtained were recorded in a specially designed form. Data was analyzed using ''SPSS'' version 15 statistical software. Results: Three hundred participants were recruited as study group and another 300 as control group. Of the participants in the study group, 61% and 39% were females and males respectively. The mean age was 29.3(SD: 8.2) years. Seventy percent had positive family history of allergy and 19% were obese. The commonest trigger of allergic symptoms was dust allergy (72.3%) and the commonest comorbidity was allergic conjunctivitis (55.7%). Allergic rhinosinusitis was most common in students (38%) and the commonest presenting symptom was nasal congestion (98%). In the study group, the lung volumes were below 90%; while lung volumes in the control group were above 90%. There was a statistically significant difference in lung volumes between the study and control groups (p = < 0.05). A large number of patients with abnormal spirometry results have total nasal symptom scores of above 5 (n=119), while few (n=7) had symptom scores of 5 and below .There was also a statistically significant correlation between high total nasal symptom scores and abnormal spirometry (chi sq=72, p =0.0001). Older age (odds ratio, 13.0), female gender (odds ratio, 10.9) and negative family history of allergy (odds ratio, 7.7) were found to be associated with abnormal spirometry results. Conclusion: There is impairment of spirometry readings in patients with allergic rhinosinusitis, even in the absence of asthma. KEY WORDS: Allergic rhino-sinusitis, Asthma, Spirometry, Co- morbidity. GUIDELINES FOR DIAGNOSIS AND TREATMENT OF PROSTATE CANCER IN WEST AFRICA: 2NDCONSENSUS CONFERENCE Samuel Osaghae Affiliation/Organization: Dept. of Surgery, University of Benin Teaching Hospital, UBTH, Benin City, Edo State, Nigeria and Dept. of Urology, Watford General Hospital, UK Email:  HYPERLINK "mailto:sosaghae@aol.com" \h sosaghae@aol.com Abstract Objective: To develop a second consensus and guideline for the management of prostate cancer in West Africa. Method: A summary of the first guideline (published at West African Journal of Medicine Volume 29 Supplement 2010: 3 32) and results of a structured questionnaire survey of West African Urologists based on the recommendations will be presented to attendees at an open consensus development conference during the 54th annual meeting of West African College of Surgeons in Kumasi, Ghana. The participants will be invited to critique, discuss, recommend and agree any changes. The outcome will form the basis for a 2nd West African consensus and guideline on diagnosis and treatment of prostate cancer. Results: The key question to be addressed is the minimum standard to be achieved in the management of prostate cancer in West Africa. The consensus and guideline will cover screening, diagnosis, staging, treatment, patient education and support groups, multi-disciplinary specialist networks, audit, research, cancer registry and urologist education. Conclusion: The guideline will state the acceptable standards to be achieved or aspired to in the management of prostate cancer in West Africa. It will identify areas of priority for audit, research, education and development. PROSTATE CANCER MANAGEMENT OF 669 CASES IN ACCRA, GHANA YEBOAH E D1, HSING A W3,4, BIRITWUM R B1, TETTEY Y1, MANTE S2, MENSAH JE1, KYEI M Y1, YARNEY J1, VANDERPUYE V1 et al 1University of Ghana Medical School (UGMS) and Korle Bu Teaching Hospital (KBTH), 237 Military Hospital Accra, 3NCI/NIH Bethesda USA, 4Cancer Prevention Institute California (CPIC). Abstract OBJECTIVES: Study clinical incidence of staged their management and outcomes. METHODS: Study of PC managed in Accra 2004 2012. Diagnosis by history, !PSA, physical (PE) and abnormal DRE. PC Gleason Scores (GS) and TNM staged and managed 86 follows: organ confined Radical prostatectomy (RP), brachytherapy (BRCHY), external beam radiotherapy (EBRT), hormonal/chemotherapy or surveillance. T34 M0 by hormonal/chemotherapy BRCHY/EBRT. Metastatic Rx hormonal/chemotherapy. RESULTS: 669 cases median age 70 years. Organ confined 415 (62%), T3T4 M0 167 (25%), Metastatic 87 (13%). Follow up 17 years. ORGAN CONFINED n =415 symptomatic 120% - Rx. RADICAL PROSTATECTOMY n =92 Prior PSA 16.1ng/ml, post PSA 0.23ng/ml. Complications (COMP) 322%. BRACHYTHERAPY n = 70 Prior PSA 14.6ng/ml, post PSA 0.59ng/ml. COMP 310% EBRT n =155. Prior PSA 15.7ng/ml, post PSA 0.54ng/ml. COMP 26% HORMONAL/CHEMOTHERAPY n= 98. Prior PSA 13.8ng/ml, post PSA 0.59ng/ml LHRH 41%, stilboestrol 29%, BTO 30%. COMP 430% Surveillance in 20 later converted to treatment LOCALLY ADVANCED n=167 (T3 100, T4 67) prior PSA 48.5ng post 0.6ng/ml GS e"7, symptomatic 60%. Rx Neoadjuvant hormonal/chemotherapy LHRH 52%, Stilboestrol 12%, BTO 36% then by Brachytherapy T3 n=3, Prior PSA 14.6ng/ml post 0.11ng/ml. EBRT n=64 Prior PSA T3 (34%) 32.4ng/ml, T4 =(2%) 64.6 ng/ml post PSA T3 0.6ng/ml, T4 0.4ng/ml. COMP 270% Hormonal/chemotherapy n=103, LHRH 28%, Stilboestrol 4%, BTO 30%, COMP 435%, mortality 26.3% METASTATIC n=87 (13%) Prior PSA 93ng/ml post PSA 0.4ng/ml. Rx LHRH 23%, Stilboestrol 17%, BTO 60%, COMP 2034%, mortality 37%. Conclusion: Prior to 2000, 15.3% PC organ confined, T3/T4 32% and metastatic 52%. Improved facilities since 2004 led to organ confined PC 62% curable by RP, BRCHY/EBRT with longer survival but advanced disease pose challenges for disease control. CLINICO-PATHOLOGICAL CHARACTERISTICS OF PROSTATE CANCER DISEASE: AN ANALYSIS OF 58 PATIENTS IN KUMASI Addai Arhin Appiah, C K Gyasi Sarpong, Ken Aboah, Roland Azorliade, Douglas Arthur, B Nyamekye, Otu Boateng, P Maison, B Twumasi, Antwi, George Amoah Correspondence: Dr A A Appiah, Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana. E-mail:  HYPERLINK "mailto:addaiarhin@yahoo.com" \h addaiarhin@yahoo.com Abstract BACKGROUND: Worldwide prostate cancer is the 6th most important cancer and is the commonest cancer among all men. Prostate cancer disproportionately affects men of black African ancestry in whom it tends to be more aggressive with poorer prognosis. Globally, the incidence and morbidity of prostate cancer is rising, affecting more men of the black African ancestry than men of all other race. Prostate cancer is the leading genitourinary malignancy in Ghana and is the second leading cause of cancer deaths in Accra. Its presentation is varied ranging from asymptomatic to metastatic disease and this has been well studied in other parts of the world where quality data and cancer registries exist. With the exception of Nigeria, Ghana, Gambia, Sierra Leone and Guinea which formed the bulk of the Trans Atlantic slave trade, little data exist on prostate cancer disease in these countries. The aim of this study is to describe the clinico- pathological features of patients presenting with prostate cancer disease in Kumasi. There specific objectives were: To determine the socio demographic features of the study population To determine the mode of presentation of the disease and To determine the histo-pathological characteristics of the patients. METHODS: We reviewed our data base on prostate cancers over a period of one year at the Komfo Anokye Teaching Hospital to describe the clinico-pathological features of prostate cancer disease seen in Kumasi. RESULTS: Over the period, 58 cases were seen. The age range was from 44 to 83 years with a mean age of 68 years/ 38.5% of them were retired civil servants representing the major occupation. 51 were symptomatic at presentation with lower urinary tract symptoms. Common complications of the disease at presentation were bone/waist pains 75%; retention of urine 48.1%, hematuria 34.6%, anemia 19.2% erectile dysfunction 19.2% and 9.6% had paraplegia. One patient had a PSA level within normal range but the majority (46%) had PSA levels ranging from 20-50ng/ml and 30% of them had PSA levels above 100ng/ml. 50% had bone metastasis at presentation. Histology revealed all the patients had adenocarcinoma of the prostate. The Gleason scores ranged from 6-9 with Gleason 7 being the most predominant (43.9%), followed by Gleason score 9 (26.8%), 6 (22%) and 8 (7.3%). CONCLUSION: Most of our patients present late with advanced disease and unfavourable tumour characteristics. We therefore recommend public health education on prostate cancer and screening programs to ensure early detection of prostate cancer. TREATMENT OF PROSTATE CANCER IN KUMASI: AN ANALYSIS OF 58 PATIENTS Addai Arhin Appiah, Ken Aboah, Gyasi Sarpong C K, Roland Azorliade, Douglas Arthur, Baah Nyamekye, Otu Boateng, Patrick Maison, Benjamin Twumasi, Isaac Antwi, George Amoah Correspondence: Dr A A Appiah, Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana. E-mail:  HYPERLINK "mailto:addaiarhin@yahoo.com" \h addaiarhin@yahoo.com Abstract BACKGROUND: Multiple treatment options are available for men with prostate cancer. The choice of treatment depends on a host of factors including clinical stage at presentation, local expertise, and availability of resources, specialty of attending physician, patient's choice and life expectancy. EtcWe present our experience with the treatment of prostate cancer among 58 patients in Kumasi. The objectives are: To determine the socio demographic features of prostate cancer patients seen in Kumasi To determine the clinical stage of the disease at presentation To describe the treatment modalities employed in Kumasi. METHODS: We reviewed our data base on prostate cancers over a period of one year at the Komfo Anokye Teaching Hospital. Information gathered included patient demographics, clinical stage and treatment offered. 87 RESULTS: Over the period, 58 cases were seen. The age range was from 44 to 83 with a mean age of 68 (38.5%) of them were retired civil servants representing the major occupation. Organ confined prostate cancers were present in 12% of the study population. 16% were locally advanced with 72% having metastatic disease. 58.7% had bilateral total orchidectomy, 26.1% had medical androgen deprivation therapy, 8.7% had active surveillance whiles 6.5% had radical prostatectomy. CONCLUSION: Most of our patients present late with advanced disease making androgen deprivation therapy the predominant mode of treatment, though palliative in nature.We therefore recommend public health education on prostate cancer and screening programmes to ensure early detection of prostate cancer and curative treatment for most patients who require it. AGE-SPECIFIC SERUM PROSTATE-SPECIFIC ANTIGEN REFERENCE RANGES AMONG LAGOS CIVIL SERVICE MEN WITHOUT PROSTATE CANCER 1Ikuerowo SO, 2Ajala MO, 1Abolarinwa AA, 1Omisanjo OA 1Urology Division, Department of Surgery, Lagos State University College of Medicine and Lagos State University Teaching Hospital, Ikeja 2Lagos State Pathology Services, General Hospital Lagos Abstract Background: Serum prostate-specific antigen (PSA) levels increase with age and varies among different races and communities. The study was aimed at defining the age-specific reference ranges of serum PSA in our environment. Methods: We evaluated the relationship between age and serum PSA levels and the age-specific reference ranges of serum PSA among civil servants in Lagos who underwent routine medical checkups. Criteria for inclusion were men who have no lower urinary tract symptoms, normal digital rectal examination and serum PSA d"20ng/ml. SPSS Statistic 21 was used for data evaluation and the mean, median, 95th percentile PSA levels were estimated. Pearson's correlation was used to examinetherelationshipandp<0.05 wasconsideredsignificant. Results: 4032 men met the criteria for inclusion in the evaluation. The mean age was 51.6 (range 40 70) years and there was a strong correlation between serum PSA levels and age (r=0.097, p<0.001). 3218 (80%), 481 (12%), 284 (7%) and 52 (1%) had PSA ranges of 0 2.5, >2.5 4.0, >4.0 10 and >10ng/ml. The mean, median and the 95th percentile PSA for the overall group were 1.84, 1.33 and 5.2ng/ml respectively. However the 95th percentile PSA levels for men aged 40 49, 50 59 and 60 70 years were 4.78, 5.47 and 8.93ng/ml respectively. Conclusion: The age-specific PSA levels among Nigerian men for each age group is higher than what was described by Oesterling for men in the Western world. We recommend these reference ranges for serum PSA for men aged e"40 years in our environment. GIANT BENIGN PROSTATIC HYPERPLASIA IN A GHANIAN: CASE REPORT APPIAH A A*, AMOAH G , GYASI SARPONG CK, AZORLIADE R, ABOAH KEK, NYAMEKYE B, OTU BOATENG, MAISON P,TWUMASI P, ANTWI I, ARTHUR D. DEPARTMENT OF SURGERY, KOMFO ANOKYE TEACHING HOSPITAL, KUMASI. *Corresponding author:  HYPERLINK "mailto:addaiarhin@yahoo.com" \h addaiarhin@yahoo.com Abstract BACKGROUND: Giant benign prostatic hyperplasia (GBPH) is a rare pathology of the prostate gland. The aim is to investigate the clinical features, diagnosis and surgical treatment of giant prostatic hyperplasia METHODS: A retrospective analysis of the clinical data of a case of GBPH was done. Relevant published literature was reviewed. RESULTS: The rare GBPH case described here presented in an 82-year-old man with refractory urine retention, recurrent episodes of hematuria, renal insufficiency and a high prostate specific antigen (PSA) value of 50ng/ml. The prostatic volume measured by ultrasound was 670g. His treatment was by open transvesical prostatectomy. Haemostasis was achieved by two stitches at the 5 and 7' o'clock positions which were loosely tied behind the 50ml balloon of the size 22ch 3-way urethral catheter and traction applied on it. The surgical specimen weighed 800g. The patient required 3 units of blood peri-operatively and was discharged on the 10th post op day. Histology showed no evidence of malignancy. A literature search revealed that, the largest ever prostate was 2410g with the second largest weighing 820g. In the second instance, patient died after surgery from hemorrhage. CONCLUSION: Giant prostatic hyperplasia is an uncommon disease and can be diagnosed by its clinical manifestations and the results of ultrasonography. The open transvesical prostatectomy appears to be a safe method of treatment and can be successfully done in low resource centres. GROSS HEMATURIA AND URINARY RETENTION AMONG MEN IN A NATIONALLY REPRESENTATIVE SURVEY IN SIERRA LEONE Hiten D Patelab, Thaim B Kamaracde, Adam L Kushnerfgh, Reinou S Groenhij, Mohamad E Allafa aJames Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD bEpidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD cCollege of Medicine and Allied Health Science, Freetown, Sierra Leone dDepartment of Surgery, Connaught Hospital, Freetown, Sierra Leone eUniversity of Sierra Leone, Freetown, Sierra Leone fDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD gDepartment of Surgery, Columbia University, New York, NY hSurgeons OverSeas (SOS), New York, NY iDepartment of International Health, Royal Tropical Institute, Amsterdam, NL jDepartment of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD Corresponding Author: Hiten D. Patel, 600 N. Wolfe Street, Park Room 223, Baltimore, MD 21287 Phone: 618-534-4942; Fax: 410-502-7711; e-mail:  HYPERLINK "mailto:hitenpatel@jhmi.edu" \h hitenpat HYPERLINK "mailto:el@jhmi.edu" \h el@jhmi.edu Presenting Author (tentative): Thaim B. Kamara Abstract Purpose: The burden of urologic disease in developing countries is largely unknown. Gross hematuria and urinary retention are classic urologic complaints that require medical attention for significant underlying pathology. We present data from Sierra Leone to estimate their prevalence and also report on barriers to care and associated disability for identified cases. Materials and Methods: A cluster randomized, cross- sectional household survey was administered in Sierra Leone using the Surgeons OverSeas Assessment of Surgical need tool as a verbal head-to-toe examination. A total of 2 respondents in each of 25 households in 75 clusters were surveyed to assess surgical needs. Data on questions related to 88 blood from the penis and the inability to urinate for men >12 years of age were included in the present analysis to determine the periodandpointprevalenceofhematuriaandurinaryretention. Results: From 3645 total respondents, 1054 (28.9%) were men >12 years old included in the analysis. Period and point prevalence of gross hematuria were 21.8 per 1,000 (95%CI 13.0-30.7) and 12.3 per 1,000 (95%CI 5.7-19.0), respectively, and for urinary retention they were 19.9 per 1,000 (95%CI 11.5- 28.4) and 4.7 per 1,000 (95%CI 0.5-8.9), respectively. Lack of financial resources was the major barrier to care. Disability assessment showed 19.1% were not able to work as a result of urinary retention and 34.8% felt ashamed of their gross hematuria. Conclusions: The results provide a prevalence estimate of gross hematuria and urinary retention for men in Sierra Leone. Accessible medical and surgical care will be critical for early intervention and management. WEST AFRICA SURGICAL ACADEMY (WASA) PROFESSIONAL EDUCATION CO-OPERATION PROJECT Stephen Murray, Professional Education Manager, Ethicon, Johnson & Johnson E-mail:  HYPERLINK "mailto:Smurray@its.jnj.com" \h Smurray@its.jnj.com +447771844490 Abstract Johnson & Johnson has long maintained a goal education healthcare professionals on the safe and efficacious use of product and providing trusted, specialty focused educational activities that maintain, develop or increase the knowledge, skills and performance of Healthcare Professionals (HCPs) in order to improve patients outcomes. The West African College of Surgeons has a strong commitment to surgical education, as detailed in its constitution; include the organization of postgraduate, coordination of education and research, cooperation national and international bodies, and the preparationandpublicationofjournals. The West African College of Surgical Academy (WASA) represents a co-operation agreement between J&J and WACS to jointly establish a modern surgical training programme at Centres of Excellence across the region in order to enhance the surgical region skills of HCPs. This will set the standard for, lead and shape the way professionals development programs for HCPs are carried out in the region, according the latest worldwide standard. THE IMPORTANCE OF INDUSTRY COMPLIANCE IN SUPPORTING THE MEDICAL PROFESSION Alban Briard Health Care Compliance Officer, Johnson & Johnson. Abstract The healthcare world can be a high-risk and challenging environment that demands a procative compliance approach. Healthcare is turning into an industry focused on Compliance and Regulation. We all want the right thing: Act with honesty and integrity in business and personal dealings. Recently, a growing number of laws, industry and cooperate guidelines have been introduced, governing how health care compliance should interact with Health Care Professionals. The intent of Health Care Compliance is to ensure the focus of our interactions with Health Care Professional remains on the genuine benefits our product brings to patients. The scope of Health Care Compliance encompasses a wide range of business practices and interaction including: consulting services, hospitality, charitable contributions and educational and research grants. Acting within the Health Care Compliance guidelines and policies will protect the Health Care Professional, healthcare companies, employees and ultimately the patient. The WASC Conference is a perfect opportunity to introduce, to share compliance topics with the Health Care Professionals but also be able to answer questions. IS IT FEASIBLE TO SET UP EXCLUSIVE ROBOTIC UNIT IN TERTIARY CARE CENTRES IN DEVELOPING COUNTRIES? CHALLENGES FACED. Sharma Ajagopal. V APOLLO HOSPITALS, HYDERABAD, INDIA Senior consultant, Dept of Urology, Lap & Robotic surgery Abstract OBJECTIVE: Here with we present the detailed account of strategy to set up exclusive robotic surgical center at tertiary care hospitals in developing countries keeping in view of identification of space or construction of new theatre and identification of man power ie identification of surgeons from various specialities,identification of Ot technicians,nurses and supporting staffs. METHODS: Cost of the robot,disposables, Annual maintenance cost, Exclusive OR charges and the revenue from OR ,Salaries of Supporting staff ,marketing strategies and money spent on marketing have been evaluated and found ,a minimum of 200-250 cases has to be performed to recover the expenses spent on robot .After 200-250 cases the only expenses incurred are disposables and instrumentation costs .methods to cut down the OR timing and minimal usage of instruments, materials ,short post op stay to offer the robotic surgery at base price have been evaluated. CONCLUSION: Robotic surgical center can be setup in a tertiary care hospital in a developing country with collective effort from surgeons including Urologists, General & GI surgeons, Gynecologists, Cardio thoracic, Head & neck surgeons and HR & marketing team. SURGICAL MANAGEMENT OF TYPHOID PERFORATION (SMTP) TRIAL: RATIONALE, CONCEPT, AND DESIGN S A Debrah School of Medical Sciences, University of Cape Coast, Ghana. Abstract BACKGROUND: Typhoid fever is a life- threatening Salmonellae typhi bacterial infection of the intestinal tract and bloodstream. It affects all age groups from a little over 1year old (Nuhu A et al, 2010).The majority are below thirty years. (Nuhu A et al, 2010, Mock CN et al, 1992) Intestinal perforation is the most serious complication of typhoid fever (nen A et al, 2002, Wani RA et al, 2006, Singh KP et al 1991) with mortality rates ranging between 20 60% in the West African sub-regions (Nuhu A et al, 2010).This high mortality in developing countries is partly due to poor infrastructure and personal and public hygiene. Surgical intervention is the main modality of treatment. Primary closure, bowel resection (with or without anastomosis and with or without ileostomy) are the various options for surgical intervention. Currently there are conflicting views regarding which of these options gives the best outcome. The aim is to determine the effectiveness and superiority of ileostomy over other forms of surgical treatment of the severely ill patient from typhoid perforation. METHODS: A multicentre randomized control trial in which 89 the intervention group will receive primary closure or resection (with or without anastomosis ) and ileostomy while the control group receives only primary closure or resection and anastomosis. The study population will be patients with American Society of Anaesthesiologists' (ASA) classification 3, 4 or 5 and have a Mannheim Peritonitis Index ( MPI) of >26. The main study will take place in three different hospitals. EXPECTED OUTCOME: It is expected that there will be lower morbidity (as measured by incidence of re-laparotomies and shorter hospital stay) and fewer mortalities in the intervention group compared to the control group. LONG CASE ORAL PRESENTATION FOR PROFESSIONAL CLINICAL EXAMINATION: THE DOCUMENTED, THE UNDOCUMENTED AND THE NEED FOR DOCUMENTATION Agodirin SO, Olatoke SA, *Agbakwuru EA, Rahman GA, **Kolawole O. Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria. *Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. **Ladoke Akintola University Teaching Hospital, Oshogbo, Nigeria. STATUS OF SURGICAL ACTIVITY IN SIERRA LEONE IN 2012. T.B. Kamara (1), Hkon A. Bolkan (2,3,5), Donald Bash-Taqi (1), Johan von Schreeb (4), Arne Wibe (2,3,5) Ministry of Health and Sanitation, Freetown, Sierra Leone CapaCare, Trondheim, Norway Department of Surgery, St Olav Hospital, Trondheim, Norway Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden Norwegian University of Science and Technology, Trondheim, Norway Abstract Background: Studies have documented that surgical and obstetrical needs are poorly addressed in low-income countries, but population based studies are lacking. The aim of the study was to collect data on all surgeries done in Sierra Leone during 2012. Methods: Nationwide exhaustive retrospective facility based survey quantifying the total number of major surgical procedures performed in Sierra Leone in 2012, their geographical variation and type, as well as characteristics of the patients, institutions and healthcare workers performing surgery. From 164 institutions potentially providing major surgery, 89 were excluded based on telephone interview and discussion within a local expert panel. Four teams visited 75 institutions over 6 weeks in January, February and May 2013. Of the 60 facilities offering surgical and obstetrical services data was obtained from the logbooks of 58 (96.7%) institutions. The most recentpopulationcensuswasusedforcalculationofrates. Results: A total of 24 152 major surgical procedures were identified, corresponding to a national rate of 400 procedures per 100 000 population (Districts ranged 32-909). 55% were reported in the private Non-Profit sector, while government facilities and the private For-Profit sector accounted for 39.6% and 6.4%. General surgery represented 45.0%, followed by obstetrics and gynecology (31.4%), ophthalmic surgery (12.4%) and orthopedic surgery (10.7%). The most commonly performed procedures were hernia repairs (21.5%), caesarean section (20.2%) and others (general surgery) (10.0%). Up to 96.2% operative fracture treatments were done in the private Non-Profit sector. Consultant Surgeons/Gynaecologists performed 47.2% of the national volume, Medical Officers 39.4% and Associate Clinicians and Nurses 13.5%. The national caesarean section rate was 2.3%. Conclusion: This study is the first that document country-wide rate of surgery in a low-income setting. The rates of major surgery and caesarean section are low in Sierra Leone, and they differ significantly between urban and rural areas. It is noteworthy that close to 100% of fracture surgeries are performed in the private Non-Profit sector. As the main service provider, the private Non-Profit sector needs to be engaged also in capacity building. More studies are needed to define the unmet need for surgery in low-income settings.  Abstract Background: The oral long case presentation is commonly an implied knowledge that requires skill, depth of knowledge, logical thinking and fluidity of mind. The challenge of the presentation is compounded by the examiners' preference(s) and poor understanding of what should be assessed.The objective is to highlight the differing opinions, misconceptions and deficits of trainers. Methods: A structured questionnaire was distributed during the WACS examination and to hospitals. Eligibility criteria included being a surgeon, a trainer and responding to all questions. Results: Of the 76 questionnaires that were returned, 36 were eligible for the current analysis. The 36 were from respondents from 14 centres in Nigeria and Ghana. Fifty-two percent were examiners in the postgraduate medical college and 25% are professors. Twenty percent of the respondents were not aware of the 3 separate methods of oral presentation for different occasions, 57 percent were aware that candidate used the 5Cs method and the traditional compartmentalized method in long case oral presentation. Only 32% gave completely appropriate responses to what should be content of formal long case presentation. Thirty- four percent were not aware of the documented sequence of examination finding presentation. Despite knowing that it is not documented, 30% want postgraduates to present differently than undergraduate and 58% say it is an unwritten rule. Forty-seven percent know that the 5cs of history of presenting complaint is not documented, yet close to 50% still teach it. CONCLUSION: We need a consensus and documentation of what we expect for the oral long case presentation. TOTAL THYROIDECTOMY: INDICATIONS AND RESULTS OF A MULTICENTRE STUDY: 66 CASES LES THYRODECTOMIES TOTALES: INDICATIONS ET RSULTATS D'UNE TUDE MULTICENTRIQUE. A PROPOS DE 66 CAS Bonkoungou P G, Sanou A, Zida M, Ouangr E, Zongo N, Lamien / Sanou A, SS Traor Correspondence: P. Gilbert Bonkoungou 11 BP 1104 Ouagadougou 11 Burkina Faso CMS  HYPERLINK "mailto:gbonkoungou@hotmail.com" \h gbonkoungou@hotmail.com Abstract Background:Total thyroidectomy, although codified procedure is rarely performed in many centres. It is deemed dangerous due to the risk of disabling postoperative complications. The purpose is reporting the indications and results of total thyroidectomy to improve the management of patients with thyroid disease. Methods: We conducted 3-year retrospective multi-centre study covering the period January1st, 2010 to December 31th, 90 2012.We inluded all patients who under went total thyroidectomy regardless of the indication. Patients were recruited in 3 surgical units. Clinical data, surgery records and post operative outcome were taken to account. Results: 66 total thyroidectomies were performed in these 3 centres. The main indications were multi nodular goiter (76.2%), hyperthyroidism (15.8%), and homogeneous euthyroid goiter (6.4). The postoperative course was uneventful in 58 cases (87.8%). Complications were limited to 4 postoperative hematoma, hypocalcemia 3 to 2 months, and trachea linjury. There was no mortality. Conclusion: With strict respect of the surgical technique rules and rigor in the performance of surgical gestures, total thyroidectomy is safe and effective for both the treatment of thyroid cancer or benign thyroid pathology. Abstract La thyrodectomie totale, intervention bien codifie est rarement pratique dans beaucoup de centres. Elle est rpute dangereuse en raison des risques de complications post opratoires parfois invalidantes. But: rapporter les indications et les rsultats des thyrodectomies totales afin d'amliorer la prise en charge des patients prsentant une pathologie thyrodienne. Patients et mthodes: il s'agit d'une tudertropective de 3 ans multi centrique qui a couvert la priode du 1er Janvier 2010 au 31 Dcembre 2012. Etaient inclus dans cette tude, tous les patients ayant subi une thyrodectomie totale quelle que soit l'indication. Les patients ont t recruts dans 3 services de chirurgie o sont effectues rgulirement des thyrodectomies. Ont t pris en compte, les donnes cliniques et paracliniques, le compt rendu opratoires et les suites post opratoires. Rsultats: 66 thyrodectomies totales ont t pratiques dans ces 3 centres. Les principales indications taient respectivement les goitres multi nodulaires (76,2 %), l'hyperthyrodie (15,8%), le goitre homogne euthyrodien (6,4). Les suites opratoires ont t simples dans 58 cas (87,8%). Les complications se rsumaient en 4 hmatomes post opratoires, 3 hypocalcmies 2 mois, et une plaie de la trache. La mortalit tait nulle Conclusion: Avec un respect strict de la technique opratoire et une rigueur dans l'accomplissement des gestes opratoires, la thyrodectomie totale peut tre une option sre et efficace aussi bien pour le traitement des cancers de la thyrode que pour celui des pathologies bnignes. SURGICAL TREATMENT OF THE SEQUELAE OF LUNG TUBERCULOSIS IN BURKINA FASO. PRISE EN CHARGE CHIRURGICALE DES SQUELLES DE TUBERCULOSE PULMONAIRE AU BURKINA FASO. Bonkoungou PG, Sanou A, Zida M, Ouangr E, Zongo N, Lamien / Sanou A, SS Traor Corresponding author: P. Gilbert Bonkoungou 11 BP 1104 Ouagadougou 11 Burkina Faso CMS  HYPERLINK "mailto:gbonkoungou@hotmail.com" \h gbonkoungou@hotmail.com Abstract Pulmonary tuberculosis is an endemic disease in developing countries. The effects are variable and sometimes lead to surgical act. Whether or not tuberculous cavity colonized by Aspergillus fumigatus or pulmonary destruction, surgery on the parenchyma remains difficult due to the potentially serious postoperative complications. Purpose: Reporting ou rexperience of surgical treatment of the sequelae of pulmonary tuberculosis in Burkina Faso Patients and methods: This is a retrospective review of patients who underwent surgery for sequelae of pulmonary tuberculosis from January 2006 to June 2013. We took into account clinical, paraclinical, therapeutic aspects and postoperative outcome. Results: During this period, 89 patients underwent thoracotomy for parietal or parenchymal disease. 26 patients (29.2 % of all thoracotomy) underwent thoracotomy for sequellae of lung tuberculosis. The indications were lung destruction in 19 cases and pulmonary aspergilloma in 9 cases. We performed 43 lung resections including 26 pulmonary tuberculosis (60.5 % of the indications of lung resections). The post-operative course was uneventful in 23 patients. Wound infection was recorded in 2 cases. One death occurred in HIV-1 patient whounderwentleftupperloberesection. Conclusion when properly indicated, lung resection can cure patients with sequelae of pulmonary tuberculosis Rsum La tuberculose pulmonaire est une affection endmique dans les pays en dveloppement. Les squelles sont variables et rclament parfois un geste chirurgical. Qu'il s'agisse de caverne tuberculeuse colonise ou non par aspergillus fumigatus ou de destruction pulmonaire, les gestes sur le parenchyme reste dlicats en raison des complications post opratoires potentiellementgraves. BUT: RAPPORTER NOTRE EXPRIENCE DE LA PRISE EN CHARGE CHIRURGICALE DES SQUELLES DE TUBERCULOSE PULMONAIRE AU BURKINA FASO PATIENTS ET MTHODE: IL S'AGIT D'UNE TUDE RTROSPECTIVE DES DOSSIERS DES PATIENTS AYANT T OPRS DE SQUELLES DE TUBERCULOSE PULMONAIRE DE JANVIER 2006 JUIN 2013. ONT T PRIS EN COMPTE LES DONNES CLINIQUES, PARACLINIQUES, LES ASPECTS THRAPEUTIQUESETL'VOLUTIONPOSTOPRATOIRE. RSULTATS : PENDANT CETTE PRIODE, 89 PATIENTS ONT T OPRS PAR THORACOTOMIE POUR PATHOLOGIE PARITALE OU PARENCHYMATEUSE; 26 PATIENTS ONT EU UNE THORACOTOMIE POUR PATHOLOGIE PULMONAIRE POST TUBERCULOSE SOIT 29,2% DES INDICATIONS DE THORACOTOMIES. LES INDICATIONS TAIENT UNE DESTRUCTION PULMONAIRE DANS 19 CAS ET UN ASPERGILLOME POST TUBERCULOSE DANS 9 CAS. NOUS AVONS EFFECTU 43 RSECTIONS PULMONAIRES DONT 26 PNEUMOPATHIES POST TUBERCULOSE, SOIT 60,5% DES INDICATIONS DES EXRSES PULMONAIRES. LES SUITES OPRATOIRES ONT T SIMPLES CHEZ 23 PATIENTS. UNE SUPPURATION PARITALE A T NOTE DANS DEUX CAS. UN DCS A T OBSERV CHEZ UNE PATIENTE INFECTE PAR LE VIH1 ET QUI A EU UNE RSECTION DU LOBE SUPRIEUR DU POUMON GAUCHE. C O N C LU S I O N L E S R S E C T I O N S P U L M O N A I R E S LORSQU'ELLES SONT BIEN INDIQUES PERMETTENT DE GURIR LES PATIENTS PRSENTANT DES SQUELLES DE TUBERCULOSE PULMONAIRE. DIAGNOSTIC AND TREATMENT OF BREAST CANCER IN THE CITY OF OUAGADOUGOU. ABOUT 65 CASES ASPECTS DIAGNOSTIQUES ET THRAPEUTIQUES DES CANCERS DU SEIN DANS LA VILLE DE OUAGADOUGOU. PROPOS DE 65 CAS. Bonkoungou PG, Sanou A, Zida M, Ouangr E, Bambara HA, Zongo N, Lamien / Sanou A, SS Traor Corresponding author: P. Gilbert Bonkoungou 11 BP 1104 Ouagadougou 11 Burkina Faso CMS  HYPERLINK "mailto:gbonkoungou@hotmail.com" \h gbonkoungou@hotmail.com Background: reportingourexperience in the management of breast cancer in the city of Ouagadougou A multicentres study was conducted in 3 surgicalunit. Wereincluded patients withbreast cancer and treated in thesecenters. Data had been 91 collected from August 1st,2010 to July 31th, 2011. Patient field records, clinical data were used. Results: 65 patients were selected for this study. The average age was 47 years. Patients whose age was between 30 and 59 years were the most frequent. 61% of women had no gainful employment .Multiparity was found in 54 patients (83%). The cancer was discovered during a routine screening in 8 cases (13 %) and clinical signs in 57 cases (87.7 %). Inflammatory tumours accounted for 21 % of cases. 7 patients had metastases at diagnosis. Histologically, ductal carcinoma was most common ( 67 % ) . The tumor was undifferentiated in 78 % of cases. Treatment was curative in 58 cases (89 %) and palliative in 7 (11 %). All patients received chemotherapy including neoadjuvant (57%). Radiotherapy was initially indicated in 35 patients but performed in 6 patients . Conclusion: Breast cancer is diagnosed at a late stage in our context. Optimization of the treatmentdepends on the availability of anticancer drugs and early diagnosis Rsum But: rapporter notre exprience de la prise en charge des cancers du sein dans la ville de Ouagadougou Patients et mthode Il s'agit d'une tude transversale multicentrique qui s'est droule dans 3 services chirurgicaux. Ont t incluses les patientes prsentant un cancer mammaire et prises en charge dans ces centres. La collecte s'est droule du 1er Aot 2010 au 31 Juillet 2011. Les dossiers des malades, les registres de consultation ont t les supports utiliss. Rsultats: 65 patientes ont t retenues pour notre tude. L'ge moyen tait de 47 ans. Les patientes dont l'ge tait compris entre 30 et 59 ans taient les plus frquentes. 61% des femmes n'avaient pas d'activit rmunratrice. La multiparit a t retrouve chez 54 patientes (83%). Le cancer a t dcouvert l'occasion d'un dpistage de routine dans 8 cas (13%) et par des manifestations cliniques dans 57 cas (87,7%). Les tumeurs inflammatoires reprsentaient 21% des cas. 7 patientes prsentaient des mtastases au moment du diagnostic. A l'histologie, le carcinome canalaire tait le plus frquent (67%). La tumeur tait indiffrencie dans 78 % des cas. Le Traitement tait curatif dans 58 cas (89%) et palliatif dans 7 (11%). Toutes les patientes ont bnfici d'une chimiothrapie dont 57% en noadjuvant. La radiothrapie a t initialement indique chez 35 patientes mais ralise chez 6 patientes. Conclusion: Le cancer du sein est diagnostiqu un stade tardif dans notre contexte. L'optimisation de la prise en charge passe par la disponibilit des mdicaments anti cancreux et un diagnostic prcoce. RENAL AND PANCREAS TRANSPLANTATION Sandeep Guleria Senior Consultant Surgeon, Indraprastha Apollo Hospital, New Delhi, India. E- mail:  HYPERLINK "mailto:sandeepguleria@hotmail.com" \h sandeepguleria@hotmail.com Kidney Transplantation is the treatment of choice for patients suffering from end stage renal disease. The excellent results of renal transplantation have made us accept both donors and recipients that we would not have accepted earlier. The live related donor is the key to a transplant program and data from us seems to indicate that live related donors have an excellent quality of life and view the gift of life as the best act they ever did in their life . Most centre's have developed a robust Pediatric transplant program to offer children the benefits of renal transplantation and we have excellent one year and 5 year graft and patient survival. However more and more people in the developing world need to be convinced about the excellent results of Pediatric transplantation Kidneys can be retrieved either through an open donor nephrectomy, a mini donor nephrectomy or laparoscopically. There is convincing data to substantiate that the mini donor and laparoscopic donor nephrectomy are today the procedure of choice for the vast number of donors. With advances in immunosuppression in renal transplantation rejection rates have continued to decline and the current challenge is towards long term graft survival . Our current one year graft survival is more than 96%. However infections continue to be a major source of concern for most transplant centresinthedevelopingworld. For insulin dependant diabetes mellitus patients who have renal failure the treatment of choice is a kidney pancreas transplant. However these require a cadaver donor and much work needs to be done to push deceased donor transplantation in the developing world. For recipients of a kidney pancreas transplantation this is a rebirth as they are off insulin and off dialysis. More over this does reverse or stop the complications of diabetes from progressing. Transplantation has been one of the most notable advances of our times and has revolutionized the lives of hundreds of patients all over the globe. ROBOTIC UROLOGICAL SURGERIES: OUR INITIAL EXPEREIENCE Sharma, Rajagopal.V. Correspondence: Dr SHARMA, DR.RAJAGOPAL.V, APOLLO HOSPITALS, HYDERABAD, INDIA Senior consultant, Dept of Urology, Lap & Robotic surgery Robotic urological procedures are all well established all over the world as the standard of care wherever it is indicated. Here with we present a series of Robotic assisted laparoscopic radical prostatectomy , Robotic renal/Adrenal surgery .We are presenting our experience of the surgery performed in our hospital Apollo Hospitals, Hyderabad, ,India from Jan 2013- December 2013. METHODS: A total of 50 robotic urological procedures have been performed.20 of them are robotic radical prostatectomies performed by a single surgeon. Average age group 50-62 years average prostate size of 30-50 gm, with an average S.PSA ranging from 6-10 ng/ml with Gleason score of (3+4), (4+3).(4+4) RESULTS: Average procedure time-4-6 hrs, Initial cases average time of 8hrs later has come down to 4 hrs & Average Blood Loss-100-200ml. Progress during hospital stay, diet on postoperative day 1,discharged after 48 hours with Catheter ,Catheter removal POD 10. Pathological staging, Continence, Impotence & stricture rates have been evaluated CONCLUSION: Robotic radical prostatectomy is an excellent procedure which offers result beyond comparable to open surgery with an excellent early recovery and also give surgeon a good dexterity in dissection and anastamosis . Technique can be mastered with a short learning curve. FIRST TRIMESTER PREDICTION OF HYPERTENSIVE DISORDERS IN PREGNANCY USING DOPPLER ULTRASONOGRAPHY Aworinde O O1*, Ayoola O O2, Loto O M1, Olufemi-Aworinde K J3 1.Department of Obstetrics & Gynaecology, Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Osun State, Nigeria 92 2.Department of Radiology, Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Osun State, Nigeria 3.Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Osun State, Nigeria Corresponding author: Olufemi Aworinde; aworindeolufemi@yahoo.com; Nigeria Objective: The aim of this prospective longitudinal study was to determine the predictive value of first trimester doppler ultrasound for hypertensive disorders in pregnancy among primigravidae in Ile-Ife, Osun state, Nigeria. Methods: Seventy-five primigravidae, who had antenatal care and delivery at Obafemi Awolowo University Teaching Hospital complex were investigated. They had doppler ultrasound between estimated gestational ages of 11 13 weeks. The pulsatility index (PI), resistance index (RI) and presence of early diastolic notch were noted. A questionnaire was designed to collect information on obstetric and socio-demographic characteristics and they were followed up until a week after delivery. Results: Ten (13.3%) of the women developed hypertensive disorder in pregnancy. Seven (70%) of them had preeclampsia; two (20%) pregnancy-induced hypertension and one (10%) preeclampsia super-imposed on chronic hypertension. Seven (70%) of them had an early diastolic notch; five (50%) had abnormal PI while 4 (40%) had abnormal RI. Results were analysed using SPSS 17. Presence of diastolic notch was statistically significant for predicting hypertensive disorder in pregnancy (p= 0.034) while PI and RI were not statistically significant. Conclusions: The results of this study showed a low predictive value of first trimester uterine artery doppler indices and development of hypertensive disorders in pregnancy. Of the three parameters that were assessed, only presence of early diastolic notch was statistically significant in predicting hypertensivedisorder in pregnancy in the first trimester. COMPARATIVE STUDY OF SERUM LIPID LEVELS IN NORMOTENSIVE AND PRE-ECLAMPTIC NIGERIAN WOMEN 1 Irinyenikan Theresa Azonima 2 Arowojolu Ayo, 2Olayemi Oladapo 1 Department of Obstetrics and Gynaecology, State Specialist Hospital, Akure, Ondo State, Nigeria. 2 Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria. Correspondence to: Irinyenikan Theresa Azonima, Department of Obstetrics and Gynaecology, State Specialist Hospital, Akure, Ondo State, Nigeria. E-mail:  HYPERLINK "mailto:tirinyenikan@yahoo.com" \h tirinyenikan@yahoo.com Background: Pre-eclampsia is a non-convulsive form of pregnancy-induced hypertension occurring in 5 to 10% of pregnancies. It is a major cause of perinatal mortality and also accounts for 17% of maternal deaths in Nigeria. Although the exact cause of pre-eclampsia is unknown however, endothelial injury which is a key factor in the pathogenesis of the disease could be due to accumulation of lipids in arterial intima cells and in macrophages. This study was performed to compare the serum lipid levels of pregnant normotensive and pre-eclamptic Nigerian women. Methods: It was a case-controlled study involving 50 pregnant normotensives and 50 pre-eclamptic women at the University College Hospital, Ibadan, making a total of 100 participants. Their venous blood (5 mls) was collected after an overnight fast of 8-12 hours and this was analysed for cholesterol, triglyceride, high density lipoprotein- cholesterol (HDL-C), very low density lipoprotein- Cholesterol (VLDL-C) and low density lipoprotein -cholesterol (LDL-C) using standard enzymatic methods. Statistical analysis was done using Chi- Square test for categorical variables, Student 't' test and one way ANOVA for differences in the mean serum lipid levels and Spearmans' correlation to find the correlation between serum lipids and pre-eclampsia. The level of significance was set at P<0.05. Results: The study showed that there was a significantly higher levels of triglyceride, VLDL-C and HDL-C in the pre- eclamptic compared to the normotensive group (P<0.05). Also as the blood pressure rises the level of triglyceride, VLDL- C and HDL-C increased with the severity of pre-eclampsia. Conclusion: Lipid levels increase in pre-eclampsia and particularly worse in women with severe pre-eclampsia. Therefore, lipids have an important role in the aetio- pathogenesis of pre-eclampsia and could be estimated during the conservative management of patients with pre- eclampsia. SOFTWARE FOR DIAGNOSIS OF HYPERTENSIVE DISORDERS IN PREGNANCY Adelaiye S M1, Shittu S.O1, Obiniyi A A2 1Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria. 2Department of Mathematics, Ahnadu Bello University, Zaria. E-mail:  HYPERLINK "mailto:samueladelaiye@yahoo.com" \h samueladelaiye@yahoo.com Phone No: +2347036021674 Abstract Background: Hypertension is the most common medical problem encountered by pregnant women; it complicates 2- 3% of all pregnancies. Hypertensive disorders in pregnancy are a major cause of maternal, fetal, and neonatal morbidity and mortality affecting both developing and developed countries. Nigeria has one of the highest maternal mortality ratios in the world, currently put at 545 per 100,000 live births. Majority of these patients are first seen by paramedics in developing countries. There are interventions that are simple and can easily be deployed to prevent these morbidity and mortality if hypertensive disorders are correctly diagnosed. Producing a diagnostic software system that is endowed with excellent real-world usability and robustness properties through the use of world-class design and development methodologies for diagnosis of hypertensive disorders in pregnancy, by imputing basic clinical information and simple investigation results, would help improve the maternal and fetal outcome. Fireworks and Visual basic were used to develop the software. It can store, search and retrieve patient's records. It can also be edited. This paper conceptualized, designed, developed and tested a software to diagnose hypertensive disorders in pregnancy, and can easily be deployed on the internet, for use by health personnel and none specialist doctors. CASE OF SUPRAVENTRICULAR TACHYCARDIA; (WOLFF- PARKINSON-WHITE VARIETY) IN PREGNANCY Oppong S A, Desiree Gyan, Boni F, UGMS, Obed S A, Kemevor-Asima D A. Departments of Obstetrics and Gynaecology, Cardio-thoracic Surgery and Anaesthesia, Korle Bu Teaching Hospital, Accra, Ghana. E-mail:  HYPERLINK "mailto:dotty_ama@yahoo.com" \h dotty_ama@yahoo.com Maternal and fetal arrhythmias occurring during pregnancy may adversely affect the lives of both the mother and the fetus. In women of reproductive age, the commonest arrhythmia is paroxysmal supraventricular tachycardia (SVT). Pregnancy has been identified as a risk factor for paroxysmal 93 SVT as a result of the associated haemodynamic, hormonal, autonomic and emotional changes. Most arrhythmias in pregnant women are not associated with organic heart disease and usually their treatment is not different from that of non--pregnant patients. They are mostly asymptomatic. However, symptoms present in about half of cases usually include shortness of breath, palpitations, dizziness, presyncope, and syncope which are similar to the minor symptoms of normal pregnancy, as such posing a diagnostic challenge unless the clinician has a high index of suspicion. SVT is not often diagnosed in our environment in the pregnant population but there are few reported cases in the developed countries most of whom were known patients followed up from the pre-pregnancy period. We therefore share our experience in the diagnosis and management of a case of supraventricular tachycardia of the Wolff-ParkinsonWhite variety in a 39-year- old G6P2+3 who presented at about 17 weeks gestation and jointly managed with thecardiologistandanaesthesiologist withafavourableoutcome. OBSTETRICS PERFORMANCE OF WOMEN WITH ADVANCED MATERNAL AGE IN AHMADU BELLO UNIVERSITY TEACHING HOSPITAL, ZARIA Bawa U S, Kolawole A O D, Abdul M A, Randawa A J, Adaji S . Dept of Obstetrics & Gynaecology, ABUTH Zaria, Nigeria. Correspondence/Presenter: Bawa US E-mail: drusbawa@ yahoo.co.uk Abstract Background: Consequent upon changes in social norms over the years, there has been an increase in the age of marriage and childbirth in women. The older parturient poses a great challenge to the managing obstetrician and a greater challenge to attaining safe motherhood. The objective is to determine the obstetric performance and complications developed during pregnancyanddeliveryofwomenwithadvancedmaternalage. Methods: The study design is retrospective (case control) study in ABUTH Zaria, Nigeria. The antenatal and delivery records of women with advanced maternal age (e" 35 years) and those within 20-25 years of age from 2002 to 2006 were reviewed. Records of 294 women with advanced maternal age were used and 322 of those aged 20-25years. Results: A total of 57% of women with advanced maternal age developed complications compared with 24% in those aged 20- 25 years. A total of 97.4% had chronic hypertension, while 26.2% had PIH. Labour was augmented in 12.2% of those that had spontaneous vertex delivery (SVD) and 6.2% had EMLSC/S. Low birth weight babies occurred in 11.6% necessitating admission into the SCBU, 5.4 % had stillborn. Conclusion: This shows the considerable risk in pregnancies of women with advanced maternal age. It is recommended that to minimize complications, ANC and skilled attendant at delivery are paramount. ULTRASOUND SCAN ASSESSMENT OF AMNIOTIC FLUID TO PREDICT PERINATAL OUTCOME AMONGST PREECLAMPTICS AT TERM IN UNIVERSITY OF ILORIN TEACHING HOSPITAL Ogunlaja, Olumuyiwa Ayotunde FAWOLE, Adegboyega Adisa, University Of Ilorin Teaching Hospital, Ilorin. Nigeria. E-mail -  HYPERLINK "mailto:lajamuyiwa@yahoo.com" \h lajamuyiwa@yahoo.com E-mail -  HYPERLINK "mailto:faafaa2005@yahoo.com" \h faafaa2005@yahoo.com Corresponding Author- Dr FAWOLE, Adegboyega Adisa, University Of Ilorin Teaching Hospital, Ilorin, Nigeria. Abstract Background: Preeclampsia is described as a disorder of widespread vascular endothelial malfunction and vasospasm that manifest clinically after 20 weeks gestation and can present as late as six weeks postpartum. The precise cause is still unknown, though many theories have been proposed. It contributes significantly to maternal and fetal morbidity and mortality. However, the focus in modern obstetric care is on reduction of maternal and perinatal morbidity and mortality through preventive strategies and prompt management of complications that may occur in both the mother and baby.The objective of this study was to determine the usefulness of ultrasound scan measurement of the amniotic fluid indices in predicting perinatal outcome in patients with preeclampsia at term. Methods: This study was an observational study and involved 120 consenting preeclamptic women as subjects and 120 women who were controls. All ultrasound assessments of amniotic fluid were performed by the researcher to limit inter-observer error. Results: Eighty four (70%) subjects had mild preeclampsia and 36 (30%) had severe preeclampsia. The mean Amniotic fluid index (AFI) and single largest pocket of amniotic fluid in preeclamptic women were 9.092.99cm, 3.331.05cm respectively, whereas in normotensive women the mean AFI and single largest pocket of amniotic fluid were 14.554.88cm, 5.441.72cm respectively. It was observed that AFI had a better relationship than single largest pocket in the prediction of perinatal outcome amongst preeclamptic women at term in the University Of Ilorin Teaching Hospital, also there was a significant statistical difference in the ultrasound measurements of amniotic fluid amongst normotensive and preeclamptic women at term. Conclusion: Ultrasound estimation of amniotic fluid in preeclamptics has been found to be a useful tool in the management of patients with preeclampsia aimed at improving the perinatal outcome. Hence, it may be considered to include the use of ultrasound in the protocol of management of this category of patients, however, randomized control trials will further justify this conclusion. METFORMIN VERSUS INSULIN IN THE MANAGEMENT OF DIABETES MELLITUS IN PREGNANCY AT THE KORLE BU TEACHING HOSPITAL Beyuo1*, K.K. Adjepon-Yamoah2,S A. Obed1, K. A. Bugyei2 1: Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital. 2: Department of Pharmacology, University of Ghana Medical School. * Corresponding author:  HYPERLINK "mailto:drbeyuo@gmail.com" \h drbeyuo@gmail.com Abstract OBJECTIVE: The aim of this study was to determine if either metformin monotherapy or metformin in combination with insulin is effective at achieving glycaemic targets compared to insulin monotherapy in the management of diabetes mellitus (DM) in pregnancy. METHODS: This was a prospective randomized controlled study involving 104 pregnant women with T2DM or GDM at 20-30 weeks gestation. It was an opened labelled trial. Patient were randomly assigned to one of the two treatment groups. Participants were followed through their index pregnancy with a 2-weekly glycaemic profile monitoring and maternal weight gain. Babies delivered were followed till the sixth week post-delivery, measuring birth weight, incidence of birth trauma and neonatal intensive care unit (NICU) admission rates. Both laboratory and clinical data were recorded and analyzed using SPSS version 16. RESULTS: The 2 HPG levels were significantly lower in the metformin group than the insulin group,p = 0.004. The mean FBG and 1HPG levels from randomization to term however did not differ between the two treatment groups. The mean 94 weight gain from enrolment to term was significantly higher in the insulin than the metformin group, p <0.0001. Babies in the insulin group were staying longer at NICU than their counterparts from the metformin treatment group. CONCLUSIONS: This study suggests metformin is more effective than insulin in lowering the 2HPG level. It significantly reduces weight gain in pregnancy complicated by diabetes compared to insulin. ACCURACY OF CAPILLARY BLOOD IN THE DETERMINATION OF PACKED CELL VOLUME AND ANAEMIA IN PREGNANCY 1*Cyril Chukwudi DIM, 1Emmanuel Onyebuchi UGWU, 2Ugochukwu Bond Anyaehie, 1Kingsley Chukwu Obioha 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital Enugu, Nigeria; 2Department of Physiology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria *Correspondence:Dr. Cyril C Dim, Department of Obstetrics and Gynaecology. University of Nigeria Teaching Hospital P.M.B. 01129, Enugu. 400001. Nigeria E-mail:  HYPERLINK "mailto:cyril.dim@unn.edu.ng" \h cyril.dim@unn.edu.ng Tel: +234 803 334 1960 Abstract Background: Packed cell volume (PCV) in pregnancy is assessed with either venous or capillary blood. However, the volumes of red cells differ between the two blood sources. Objectives: To determine the accuracy of capillary blood for the determination of actual PCV and anaemia among pregnant women in Enugu, Nigeria. Methods: PCV was estimated using pairs of venous and capillary blood specimens of 200 consecutive pregnant women at the antenatal clinic of UNTH, Enugu, Nigeria, from May to June 2012. Anaemia was defined as a venous PCV (vPCV) of less than 33.0%. Results: Participants' capillary PCV (cPCV) (median = 34.0%, IQR = 31.0-35.8) was significantly lower than their vPCV (median = 34.0%, IQR = 32.0-37.0), (Z = - 6.85, P < 0.001). Using venous blood as the gold standard, the mean systematic error for cPCV was -2.3 4.44% (range = -12.514.7). Also, the sensitivity and specificity of cPCV for the determination of anaemia in pregnancy were 93.0% and 89.5% respectively. Area under the curve (AUC) of the ROC curve showed an overall high accuracy of cPCV for determination of anaemia in pregnancy (AUC = 0.963, p < 0.001) Conclusions: Generally, capillary blood PCV showed high accuracy for the determination of anaemia in pregnancy in Enugu, Nigeria. However, it systematically underestimates the venous PCV in the study population which may have clinical implication as regards the decision to transfuse. Therefore, maternity units should use venous blood for PCV estimation when moderate or severe anaemia are suspected. Asymptomatic Bacteriuria among Pregnant Women with Sickle Cell Trait in Enugu, Southeastern Nigeria Obiora C C1, Dim C C2, Ezegwui H U3, Nwogu-Ikojo EE4, Okeudo C5 Department of Obstetrics and Gynaecology, 1 2,3,4 University of Nigeria Teaching Hospital Enugu (UNTH), Nigeria; 5Imo state University Teaching Hospital Orlu (IMSUTH), Nigeria Email:  HYPERLINK "mailto:drobiora2000@yahoo.com" \h drobiora2000@yahoo.com Abstract Background: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute cystitis and pyelonephritis, especially among women with sickle cell disease. This study compared the prevalence, pattern, and microbiological characteristics of ASB in pregnancy between sickle cell trait (HbAS) and normal haemoglobin (HbAA) genotype subjects. Methods: Culture and sensitivity of mid-stream urine samples were collected from 300 HbAS women and 300 matched HbAA control at the antenatal clinic of University of Nigeria Teaching Hospital Enugu, Nigeria from August 2010 to December 2011. Analysis was both descriptive and inferential at 95% confidence levels. Results: Prevalence of ASB in HbAS and HbAA women were 32.7% (98/300) and 32% (96/300) respectively [OR=1.03 (95% CI 0.73, 1.45)]. E. coli was the commonest organism isolated in both the HbAS group (56.1%, 55/98) and control group (61.4%, 59/96), [OR=0.80 (95% CI 0.45, 1.42)]. The antibiotics with the highest microbial sensitivity were ciprofloxacin 90.8% (89/98) and gentamicin 100% (98/98) for HbAS and HbAA women respectively. Conclusions: The prevalence of ASB in pregnant women with HbAS in Enugu, Nigeria was high and did not vary significantly from that of woman with HbAA. Therefore, pregnant women irrespective of their sickle cell status would benefit from routine screening for asymptomatic bacteriuria. Key Words: Asymptomatic bacteriuria, pregnant women, sickle cell trait, Enugu- Nigeria ANTIPHOSPHOLIPID ANTIBODIES AMONG PREGNANT WOMEN WITH RECURRENT FETAL WASTAGES IN ZARIA, NORTHERN NIGERIA. Abdullahi ZG, Abdul MA, Aminu S1, Musa BOP2. Reproductive Health Unit, Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria Nigeria Department of Hematology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria Immunology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria Nigeria Correspondence: Abdullahi Z G. Email:  HYPERLINK "mailto:abdullahizg@yahoo.com" \h abdullahizg@yahoo.com Abstract Background: The association between antiphospholipid antibodies (APA) and pregnancy loss has been established and now regarded as a treatable cause of pregnancy loss. Data on the prevalence of APA in our environment is scarce. The objective was to determine the prevalence of antiphospholipid antibodies in pregnant clients with and without recurrent fetal wastage. Method: The study is a case-control study conducted at tha Antenatal clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. The design is a case-control study of eighty-five antenatal clients with recurrent foetal wastage attending antenatal clinic of ABUTH and equal number of antenatal clients without recurrent foetal wastage matched for age were studied. Their socio-demographic data were obtained and their blood samples analyzed for lupus anticoagulant using APTT, DRVVT, hexagonal phospholipids and IgG anticardiolipin antibody using ELISA. The data was analyzed with SPSS 17. Results: The mean age of the clients was 30.2 years +/- 5.1 years. The prevalence of APA was 14.1% among the cases and 4.7% among the controls. The prevalence of LA was 7.1% and 1.2% among the cases and controls respectively, while ACA was 8.2% and 3.5% respectively. However, one of the cases was positive for both APA and ACA, giving a prevalence of 95 1.2%. Therefore this explains why the sum of the prevalence of LA and ACA is higher than that of APA. Conclusion: The prevalence of APA among antenatal clients with recurrent pregnancy loss is at least three times higher than that of normal antenatal clients. APA should be included in the investigation protocol of women with recurrent fetal wastages. Key words: Antenatal clients, recurrent pregnancy loss, Antiphospholipid antibodies, lupus anticoagulant, anticardiolipin antibody. EVALUATION OF SERIAL RAPID TEST ALGORITHM (WITH DETERMINE AND UNIGOLD HIV KITS) IN DIAGNOSIS OF HIV ANTIBODIES AMONG PREGNANT WOMEN IN NNEWI SOUTH EAST NIGERIA. Mbachu II, Udigwe G O, Okonkwo Jen, Ikechebelu J I, Umeononihu O S, Mbachu C N P. Corresponding author: Dr Mbachu II, Department of Obstetrics and Gynaecology, Imo State University Orlu campus. Email:  HYPERLINK "mailto:imbachu@yahoo.com" \h imbachu@yahoo.com Abstract Background: Accurate HIV testing is a critical entry point to the implementation of prevention of mother to child transmission of HIV infection and linkages to other preventive and therapeutic programmes. Methods: This was a comparative descriptive study conducted over a 4-month period. This study determined the sensitivity, specificity and positive predictive value of serial rapid testing for HIV among pregnant women in Nnewi. Conventional ELISA and serial rapid test algorithm were used to screen all the women after obtaining consents. All the subjects also filled a questionnaire. Western blot HIV test was conducted on all the positive and discordant subjects. Data analysis was done using SPSS version 20. The confident interval was 95%. Result: A total of 166 pregnant women participated in this study. The mean age of the participants was 29+-4.3 years. The peak age in HIV prevalence was in the 25-29 year age category. This was also the modal age category. Majority of the women were multiparous. The prevalence of HIV infection was 12%. The sensitivity, specificity and positive predictive value of serial rapid HIV testing was 95%, 100% and 100% respectively. Conclusion: The sensitivity of the serial rapid test algorithm was high but still lower than the WHO recommended 99% and above. The 100% specificity and positive predictive value makes it a good diagnostic test strategy. There is need for regular review of HIV test kits and policy. Key words: Serial rapid HIV test algorithm, Pregnant women, sensitivity, specificity, COLIC OESOPHAGOPLASTY FOR CAUSTIC SOPHAGAL STENOSIS: REPORT ON TWO CASES Sanou A, Bonkoungou P G, Sissoko M L, Zongo N, Windsouri M, Bayikoro I, Ouangr E, Bazongo M, Kabor M, Zida M, Traor S S Service de chirurgie gnrale, Hpital National Blaise Compaor Service de chirurgie gnrale, CHU Yalgado Oudraogo Abstract Background: Oesophagal caustic stenosis is rare but grave. In some cases, a complex surgery can be used to permit the patient ralimentation. We report the results of retro-sternal colic oesophagoplasty performed in 2 patients with oesophagal caustic stenosis. Cases: Two patients, 25 and 40 years old, were admited for a complete dysphagia and weight failling after ingestion of sulfuric acid. The physical examination found dehydration in the 2 cases. The barium oesophagal transit showed a multiple oesophagal and gastric stenosis in one case, and in the second, a complete stenosis of the cervical oesophagus. We performed in a first time a stomia for alimentation, with improved the weigth. In a second case, an oesophagoplasty using the transverse colon was performed for the 2 patients. We registered a late fistula in the cervical anastomosis in one patient which closed spontaneously one week later. Post- operative chest and abdomen radiography, with contrast, performed after one monthe did not show any fistula in the two cases. Conclusion: The retrosternal colic oesophagoplasty is a right therapeutic choice for caustic stenosis of oesophagus, when dilatation is impossible or when results are not satisfactory. Key words: Stenosis, sophagus, plasty, colon OESOPHAGOPLASTIE COLIQUE POUR STENOSE CAUSTIQUE DE L'SOPHAGE. A PROPOS DE DEUX CAS. Sanou A, Bonkoungou PG, Sissoko ML, Zongo N, Windsouri M, Bayikoro I, Ouangr E, Bazongo M, Kabor M, Zida M, Traor SS Service de chirurgie gnrale, Hpital National Blaise Compaor Service de chirurgie gnrale, CHU Yalgado Oudraogo Introduction: La stnose caustique de l'sophage est une pathologie rare mais grave dont la prise en charge peut ncessiter des gestes chirurgicaux complexes afin mde permettre une ralimentation du patient. Nous rapportons les rsultats de l'oesophago-plastie colique rtro-sternale chez 2 patientsprsentantunelsioncaustiquedel'sophage. Observations: Il s'agit de 2 patients gs de 25 et 40 ans, admis aprs ingestion d'acide sulfurique. Ils prsentaient une dysphagie complte et un amaigrissement. L'examen notait une dshydratation dans les 2 cas. Le transit oesophagien montrait une stnose tage de l'sophage et de l'estomac chez l'un et chez le second, une stnose complte de l'orsophage au niveau cervical. Aprs une ranimation, les patients ont bnfici dans un premier temps d'une stomie d'alimentation qui a permis une prise de poids. Dans un second temps, une oesophago-plastie colique transverse retrostrrnale a t ralise pour les 2 patients. Les suites opratoires ont t marques par une fistule anastomotique cervicale post-opratoire tardive chez un patient, qui a tarie spontanment. Le TOGD post-opratoire a montr une bonne permabilit du montage dans les 2 cas un mois de l'opration. Conclusion: L'oesophago-plastie colique rtro-sternale est une bonne alternative dans les stnoses caustiques de l'sophage, lorsque la dilatation est impossible ou ne donne pas un rsultat satisfaisant. Mots cls: Stnose, sophage, plastie, clon Colon-flap Pharyngoesophagoplasty Mark Tettey, Frank Edwin, Martin Tamatey, Ernest Aniteye, Ernest Ofosu Appiah. National Cardiothoracic Centre, Korle Bu Teaching Hospital. Korle Bu, Accra. Abstract O b j e c t i v e : S u r g i c a l m a n a g e m e n t o f s e v e r e pharyngoesopageal stricture from caustic ingestion is a challenge. This is because swallowing mechanism and protection of the airway during swallowing are usually destroyed by extensive pharyngeal scarring. The need for a surgical procedure to restore normal swallowing without 96 a s p i r a t i o n b e c o m e s i m p e r a t i v e . C o l o n - F l a p pharyngoesophagoplasty was developed to restore near normal swallowing after recovery from surgery without aspiration. Method: Three cases with severe pharyngoesophageal strictures aged 16 years, 4 years and 18 years respectively underwent colon flap pharyngoesophagoplasty. The proximal end of a retrosternally tunneled left colon pedicled on the left colic artery was fashioned in each case into a flap. This was used to reconstruct the posterior wall of the oropharynx and the hypopharynx after a longitudinal incision was made posteriorly in the scarred pharynx. Results: The three patients are eating and swallowing without significant dysphagia after 24, 7 and 2 months of follow-up respectively. Conclusion: Colon-flap pharyngoesophagoplasty is a safe and an appropriate procedure for selected patients with severe pharyngoesophageal stricture. To the best of our knowledge, this procedure has not been described in literature. PRELIMINARY EXPERIENCE WITH VASCULAR TRAUMA IN A NIGERIAN TEACHING HOSPITAL Salisu Ismail, Bode Falase, Michael Sanusi, Mgbajah Ogadinma. Cardiothoracic surgery division, department of surgery, Lagos State university teaching hospital, Ikeja. Correspondent to Author: Dr. Salisu Ismail, Senior Registrar in Cardiothorcic Surgery, Cardiothoracic Surgery unit, Department of Surgery of Lagos State University Teaching Hospital, Ikeja - Nigeria. E mail:  HYPERLINK "mailto:salisuismail@yahoo.com" \h salisuismail@yahoo.com,  HYPERLINK "mailto:dismail292@yahoo.co.uk" \h dismail292@yahoo.co.uk Abstract Background: The management of vascular trauma can be very challenging, especially in developing countries. There is limited information on the management of vascular trauma in Nigeria. The aim of this study was to describe our experience with vascular trauma in a Nigerian teaching hospital. Methods: This was a retrospective cross-sectional study. It included all consecutive patients that presented with vascular trauma to our institution between December 2007 and November 2013. The data was extracted from a prospectively maintained database. Results: Fifty-two (52) patients were seen in the study period. The sex distribution was 48 males (92.3%) and 4 females (7.7%). The mean age at presentation was 29.1 + 13.2 years. The distribution of injuries was brachial artery in 22 patients (42.3%), Femoral artery in 10 patients (19.2%), popliteal artery in 5 patients (9.6%), radial artery in 5 patients (9.6%), subclavian artery in 2 patients (3.8%), external jugular vein in 2 patients (3.8%) and axillary artery, ulnar artery, superior mesenteric artery, lingual artery, common peroneal artery and superficial temporal artery in 1 patient (1.9%) respectively. The cause of vascular trauma was gunshot injury in 19 patients (36.5%), RTA in 13 patients (25%), glass injury in 9 patients (17.3%), stab injury in 8 patients (15.4%) and iatrogenic injury in 3 patients (5.8%). 32 patients (61.5%) presented less than 6 hours following the incident, 7 (13.5%) presented between 6 and 24 hours after the incident, while the remaining 13(25%) presented after 24hours. Surgical intervention performed was interposition grafting with reverse saphenous vein in 16 patients (30.8%), vessel ligation in 13 patients (25%), direct repair in 9 patients (17.3%), interposition grafting with PTFE in 8 patients (15.4%) and limb amputation in 5 patients (9.6%). One patient declined surgicaltreatment. Nomortalitywasrecordedinthisseries. Conclusion: Most vascular injuries referred to the cardiothoracic division were due to gunshot and stab injuries. Early referral for prompt intervention is advocated in order to avoid irreversible ischaemic injury which may result in loss of limb. COMPARING CONTRAST ENHANCED ULTRASONOGRAHPHY AND COMPUTED TOMOGRAPHIC ANGIOGRAPHY DURING FOLLOW UP OF PATIENTS AFTER ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC ANEURYSM 1B.D. Sarkodie,2. K.H. Tay. 1 Consultant, Dept of Radiology, Tamale Teaching Hospital, Ghana. 2 Professor, Dept of Vascular and Interventional Radiology, Singapore General Hospital, Singapore Abstract monitoring of patients after endovascular repair of abdominal aortic aneurysm. The aim of this study was to determine if contrast-enhanced ultrasonography (CEUS) provides comparable results to CTA in the detection of endo-leaks in patients after abdominal aortic stent graft placement. Methods: A retrospective review of 84 (42 CEUS and 42 CTA ) studies done between August, 2007 and November, 2013 during post stent graft insertion follow up were analysed. Second-generation contrast agent (Sonovue) and low- mechanical index technique were used for ultrasonography imaging. Results: Computed tomographic angiography showed four cases of type I, fifteen cases of type II, and no endo-leaks in twenty three examinations. In 83.3% of the studies (35 out of 42 studies), the results of CEUS were consistent with the results of CTA. In two of the studies, type II endo-leak was detected with CEUS while CTA was negative. Conclusion: Contrast-enhanced ultrasonography and CTA examinations in patients after endovascular repair of abdominal aortic aneurysm provide comparable results. CEUS may be considered an alternative technique to CTA. Key words: ultrasonography, contrast agent, endovascular, aneurysm THORACIC TRAUMA IN A NIGERIAN TEACHING HOSPITAL Salisu Ismail, Bode Falase, Michael Sanusi Cardiothoracic Surgery Unit, Department of Surgery, Lagos State University Teaching Hospital, Ikeja. Correspondence: Dr. Salisu Ismail, Senior Registrar, Cardiothoracic Surgery Unit, Department of Surgery, Lagos State University Teaching Hospital, Ikeja. Nigeria.  HYPERLINK "mailto:abumusabuljahuny@gmail.co.uk" \h E-mail:abumusabuljahun HYPERLINK "mailto:y@gmail.co.uk" \h y@gmail.co.uk Abstract Background: Chest trauma is among the major causes of morbidity and mortality all over the world. There is need to highlight its pattern and presentation in order to enable designing proper preventive measures especially in developing and under developed communities. This study is aimed at analyzing the pattern, presentation and management outcome of patients presented with chest trauma over the period of study. Methods: This was a retrospective cross-sectional study. It included all consecutive patients that presented with vascular trauma to our institution between December 2007 and 97 November 2013. The data was extracted from a prospectively maintained database. Relevant demographic data, mode of presentation, nature of injury, management and outcome were studied. Results: 254 patients were seen in the study period. The sex distribution was 205 males (80.7%) and 49 females (19.3%). The mean age at presentation was 34.3 + 15.2 years. 170 patients (66.9%) are between the age of 18 and 45. The distribution of injuries was Haemothorax in 78 patients (30.7%), haemopneumohorax in 52 patients (20.5%), rib fracture in 40 patients (15.7%), pneumothorax in 38 patients (14.9%), Chest pain in 25 patients (9.8%), pulmonary contusion in 12 patients (4.7%), diaphragmatic hernia in 5 patients (2.0%), aortic dissection in 2 patients (8.0%) and Chronic empyema thoracic andpericardialeffusionin 1 patient(0.4%) each. The cause of chest trauma was motor vehicular crash (MVC) in 111 patients(43.7%), Gunshot injury(GSI) in 49 patients(19.3%), Stab injury in 47 patients (18.5%), Fall from Height in 21patients(8.3%), Motorcycle injury in 18 patients (7.1%), Fallen object in 3 patients (1.2%), Hit on the chest in 2 patients (0.8%), Fall(during foot ball) in 2 patients (0.8%) and Iatrogenic (during cardiopulmonaryresuscitation) in 1 patient(0.4%). The distribution of the victims from automobile accident are 71 passengers (55.0%), 39 pedestrian (30.2%), 10 motorcycle drivers (7.8%) and 9 vehicle drivers (7.0%). Two hundred and seventeen patients (85.4%) presented at surgical emergency department, 30 patients (11.8%) were seen in the outpatient's clinic and 7 patients (2.8%) as in-hospital referrals. While most patients (159) presented with blunt chest trauma, the remaining were penetrating injuries (95 patients). Two patients presented with aortic dissection and all died during resuscitation. Surgical intervention performed was closed thoracostomy tube drainage(CTTD) in 160 patients (63%), emergency thoracotomy in 9 patients (3.5%), diaphragmatic hernia repair in 7 patients (2.8%), decortication and pericardial window in one patient (0.4%)respectively. 76 patients (30%) were managed non operatively. Among the associated extrathoracic injury head injury constituted 32.4% (11 patients), blunt abdominal injury 20.6% (7 patients), musculoskeletal injury 14.7% (5 patients), poly trauma and spinal code injuries 11.8% each and maxilla-facial injury accounting for 8.8% (3 patients). The overall mortality rate was 5.5%. Conclusion: Pattern of thoracic trauma in Lagos is similar to most developing countries with the motor vehicular crash being the major cause followed by gunshot injuries. Most patients are in their reproductive age group, male being the most affected. There is need to put preventive measures in place and improve services in the health facilities in order to curtail its dreaded complications. OPEN-HEART SURGERY IN SICKLE CELL HEMOGLOBINOPATHY WITHOUT EXCHANGE TRANSFUSION: RESULTS OF A MATCHED-PAIR ANALYSIS Frank Edwin *, Ernest Aniteye, Mark Tettey, Lawrence Sereboe , Martin Tamatey, Kow Entsua-Mensah, Baffoe Gyan, David Kotei, Ernest Ofosu-Appiah, Kwabena Frimpong-Boateng. National Cardiothoracic Centre, Korle-Bu Teaching Hospital, P. O. Box KB 846, Korle-Bu, Accra, Ghana *Author for correspondence: Dr Frank Edwin, National Cardiothoracic Centre, P O Box KB 591, Korle Bu, Accra- Ghana.  HYPERLINK "mailto:frankedwingh@gmail.com" \h frank HYPERLINK "mailto:edwingh@gmail.com" \h edwingh@gmail.com. Abstract Objective: We sought to determine whether our institutional protocol that avoids peri-operative exchange transfusion for cardiopulmonary bypass (CPB) surgery in sickle cell hemoglobinopathy (SCH) patients increased mortality or important SCH-related complications. Methods: Matched-pair case-control methodology was adopted. SCH patients were matched with controls (hemoglobin AA) according to sex, age, weight, and type of intra-cardiac procedure to evaluate outcome. Results: Twelve sickle cell disease (SCD) and 20 sickle cell trait (SCT) patients were matched to similar controls. Age and weight were 13.46.7 years, 37.322.5kg for SCD patients; 15.912.2 years, 39.121.0kg for SCT patients. Operative procedures included valve repair and replacement, and repair of congenital cardiac malformations. Preoperatively, SCD patients were anaemic (9.51.7g/dl vs. 13.21.6g/dl; p=0.001). Systemic hypothermia (25.0-33.5C), aortic cross- clamping, cold crystalloid cardioplegia and topical hypothermia were used. CPB conditions and duration were similar for SCH and control patients undergoing. No mortality occurred among SCD/SCT patients. No vaso-occlusive crisis, acute chest syndrome, stroke, or renal failure was observed. SCD patients required more blood transfusion (702.1365.3ml vs. 395.8431.9ml; p=0.048) to replace blood loss and counter hemodilutional anemia. Intensive Care Unit/hospital stays were similar for SCH patients and controls. Conclusion: Peri-operative exchange transfusion is not essential for a good outcome in SCH patients undergoing CPB. A conservative transfusion regimen to replace blood loss and counter hemodilutional anemia is recommended. Use of systemic hypothermia during CPB does not increase the incidence of SCD-related complications. Cold crystalloid cardioplegia and topical hypothermia provide adequate and safe myocardial protection without the need for more sophisticated measures. SEPARATION OF CONJOINED HEARTS IN THORACOPAGUS SIAMESE TWINS YES WE CAN BUT SHOULD WE? Edwin F1*, Entsua-Mensah K1, Yao N-A1, Tamatey M1, Etwire V2, Appeadu-Mensah W2, Paintsil A2, Baddoo H3, Edusei L4. National Cardiothoracic Centre, Korle Bu, Accra. Department of Surgery, Korle Bu Teaching Hospital, Accra. Department of Anaesthesia, Korle Bu Teaching Hospital, Accra. Department of Pathology, Korle Bu Teaching Hospital, Accra. *Corresponding author:  HYPERLINK "mailto:frank.edwin@cardio.com.gh" \h frank.edwin@cardio.com.gh Abstract Until recently, conjoined twins only aroused the curiosities of the medical profession but no real treatment options were offered. Recent advances in pediatric cardiology and cardiac surgery have increased the possibilities of surgical separation for twins with conjoined hearts in well-resourced centres. The spectrum of abnormalities found in such conjoined hearts is protean; the attempts at successful separation are almost universally futile. The moral justification for attempting such high risk procedures with attendant high financial costs to society is debatable. We have recently encountered three pairs of such twins with unfavourable outcome: the first pair was stillborn, and the morphology of their conjoined hearts was defined as a post- mortem procedure; we performed emergency separation of the conjoined hearts at 24 hours of life in the second pair when the imminent demise of one twin threatened the survival of the other who survived the separation but succumbed to respiratory failure after 7 days; operation was denied to the third, a pair of dicephalic dibrachius parapagus twins who survived for only a month. Our experience with the management of conjoined hearts in thoracopagus twins is consistent with what is evident in the scientific literature: In the current era, successful surgical separation of conjoined hearts in thoracopagus twins remains 98 largely elusive. When cardiac separation is possible, respiratory failure from hypoplastic lungs and flail chest remain important confounders of survival. The ethical justification for performing such high-risk complex procedures especially in resource-poor settings remains debatable. TOTAL INTRA-CARDIAC REPAIR OF CYANOTIC CONGENITAL HEART DISEASE IN ACCRA -20 YEARS EXPERIENCE Tamatey M N, Sereboe L A, Tettey M M, Edwin F, Entsua- Mensah K, Gyan B and Adzamli IK National Cardiothoracic Centre, Korle-Bu Teaching Hospital, P. O. Box KB 846, Korle-Bu, Accra, Ghana Correspondence: Dr Martin Tamatey.  HYPERLINK "mailto:mtamatey@yahoo.com" \h mtamatey@yahoo.com Abstract Objective: Congenital heart disease is broadly classified as cyanotic or acyanotic. We decided to analyse the spectrum of cases of cyanotic congenital heart disease that had total intra- cardiac repair in this Centre and the outcome over a 20-year period. Methods: A retrospective study was done for all patients who had intra-cardiac repair for cyanotic congenital heart disease from January 1992 to December 2011. Results: There were 115 cases, with 56.5% of them being male. The modal age group was 5 9 years (45.2%), with a mean of 8.5 5.3 years. Tetralogy of Fallot (TOF) comprised the majority of cases 108 (93.1%), with double outlet right ventricle (DORV) forming the remaining 7 (6.9%). Most of the TOFs 78 (72.2%) needed palliation with the Modified Blalock-Taussig Shunt (MBTS), whilst the remaining 30 (27.8%) had primary correction. The mean duration of an MBTS before total repair was 2.3 years. Ten (9.3%) of the TOF patients had bilateral MBTS due to occlusion of the first shunts. The overall complication rate was 22 (19.1%). This was due to bleeding requiring re- exploration 1 (0.9%), acute renal failure requiring dialysis 1 (0.9%), complete heart block requiring permanent pacemaker implantation 4 (3.4%) and 30-day mortality of 16 (13.9%). Conclusion: Total intra-cardiac repair is the logical conclusion in the management of most cyanotic congenital heart diseases presently. The outcome from this study is good and it falls within acceptable limits. INTRACARDIAC REPAIR OF DOUBLE-OUTLET RIGHT VENTRICLE (DORV) UTILITY OF CT ANGIOGRAPHY (CTA) IN SURGICAL DECISION-MAKING Edwin F*, Yao N-A, Entsua-Mensah K, Gyan B, Assiamah S. National Cardiothoracic Centre, Korle Bu Teaching Hospital,Accra. Abstract Background: Precise preoperative imaging in double-outlet right ventricle (DORV) is fundamental to a good surgical outcome. We sought to determine the clinical utility of 64-slice cardiac CT angiography (CTA) in the anatomical diagnosis and surgical decision-making in DORV patients presenting for repair. Methods: Consecutive patients referred for surgical repair of DORV between September 2011 and December 2013 were enlisted. Their clinical notes, echocardiograms, and CTA images were analyzed. Results: There were 37 patients of mean age 7.1 5.1 years and weight 20.1 9.8 kg. Cardiac CTA was performed in 27 patients. The phenotypic features of DORV encountered were the tetralogy-type (48.7%), the VSD-type (21.6%), remote VSD- type (27.0%), and the Taussig-Bing or TGA-type (2.7%). Utility of CTA was shown for the following indications: inconclusive anatomical diagnosis, uncertain origin of a great artery, evaluation of branch pulmonary artery confluence, and preoperative planning concerning the feasibility of intra- ventricular repair. Intra-ventricular tunnel repair was accomplished in 14 patients with 2 hospital deaths (14.3%). Eleven systemic-pulmonary artery shunts were performed in 10 patients with no mortality; 7 of these subsequently underwent intra-ventricular tunnel repair. Three patients were inoperable on account of hypertensive pulmonary vascular disease. Thirteen patients need conduit repair not currently available locally. The rest are lost to follow up. Conclusion: The clinical utility of 64-slice cardiac CTA as an adjunct to echocardiographic evaluation for surgical repair of DORV is confirmed for 4 major indications. The decision to undertake intra-ventricular tunnel repair is greatly facilitated by cardiac CTA. MITRAL VALVE REPLACEMENT IN SEVERE KYPHOSCOLIOSIS PATIENT. Baffoe-Gyan K*, Sereboe L.,Edwin F, Tettey M, Tamatey M, Entsua-Mensah K, Delsol-Gyan D, Aniteye E, Ofosu-Appiah, Kotei J, I. Adzamli National Cardiothoracic Centre, Korle-Bu Teaching Hospital, P.O.Box KB 846, Korle Bu, Accra, Ghana. *Corresponding author:  HYPERLINK "mailto:gyankofi@yahoo.ca" \h gyankofi@yahoo.ca Case report Summary: On the basis of reduced lung volume and chronic hypoxemia, patients with long-standing dorsal kyphoscoliosis tend to develop pulmonary arterial hypertension and cor pulmonale. Pulmonary arterial hypertension is a well documented risk factor for open heart surgery. We recently encountered a 16 year-old girl referred for surgery on account of severe mitral valve regurgitation and tricuspid regurgitation. Severe pulmonary hypertension and cor pulmonale were documented preoperatively. Respiratory function testing that showed a severe restrictive lung disorder not responsive to bronchodilators. The preoperative risk was judged to be substantial. She was optimized preoperatively and underwent successful mitral valve replacement and tricuspid valve repair. The challenges encountered in the patient's management are discussed in this paper. RESULTS OF SURGICAL REPAIR OF AORTIC ANEURYSMS AND DISSECTIONS IN GHANA Kofi Baffoe-Gyan*, Lawrence Sereboe, Frank Edwin, Mark Tettey, Martin Tamatey, Kow Entsua-Mensah, Desiree Delsol-Gyan, Ernest Aniteye, Ernest Ofosu-Appiah, David Kotei. *Corresponding author:  HYPERLINK "mailto:gyankofi@yahoo.ca" \h gyankofi@yahoo.ca National Cardiothoracic Centre, Korle Bu Teaching Hospital, P.O. Box KB 846, Korle Bu, Accra, Ghana. Abstract Background: We evaluated the outcome of surgical repair of aortic aneurysms and dissections performed in our institution over a 20 year period. Methods: We retrospectively analyzed the records of all cases of aortic aneurysm and dissection who underwent surgical repair in our institution between 1993 and 2013. The institutional record database provided the necessary information. 99 Results: A total of 42 patients were enrolled in the study made  SHAPE \* MERGEFORMAT  up of 28 males (66.7.0%) and 14 female patients (33.40%). There were 34 aortic aneurysms and 8 aortic dissections. Aortic aneurysms were commonly located in the infrarenal region (29 patients and 85.3%) while all dissections were of the Stanford type A variety. Patients with aortic aneurysms were 10 years older than those with aortic dissections (58 8 years vs. 48 9 years). Uncontrolled hypertension was the predominant risk factor, present in 98% of all patients in whom the lowest recorded blood pressure was 170/98mmHg. Surgical repair was accomplished in all patients with a 30-day mortality of 9.5% (4 patients). Mean Intensive Care Unit Stay was 5.4 0.62 days with total in-patient stay of 18.6 2.6 days. On long-term follow up, mortality observed in the first three years were 5.2% (2 patients in 1st year), 8.1% (3 patients in 2nd year) and 5.9% (2 patients in 3rd year) respectively. Conclusion: Aortic dissections occur a decade earlier than aortic aneurysms in Ghana. Surgical repair has acceptable outcomes. Even after surgical repair, significant on-going mortality is observed on the basis of poor control of major risk factors. SYMPHALANGISM IN A NIGERIAN FAMILY: A CASE REPORT Salisu Ismail, Bode Falase, Michael Sanusi, Mgbajah Ogadinma Cardiothoracic Surgery unit, Department of Surgery of Lagos State University Teaching Hospital, Ikeja. Correspondence: Dr. Salisu Ismail, Senior Registrar in Cardiothorcic Surgery, Cardiothoracic Surgery unit, Department of Surgery of Lagos State University Teaching Hospital, Ikeja , Nigeria. E mail:  HYPERLINK "mailto:salisuismail@yahoo.com" \h salisuismail@yahoo.com,  HYPERLINK "mailto:dismail292@yahoo.co.uk" \h dismail292@yahoo.co.uk Abstract Symphalangism is a rare congenital abnormality characterized by partial or total absence of interphalangeal joints of both fingers and toes. It is inherited in an autosomal dominance pattern. Both proximal and distal interphlangeal joints can be affected, but proximal interphalangeal joint involvement is much common. The condition may be associated with skeletal or non-skeletal abnormalities. Compensatory hyperflexibility of joints proximal and distal to the fused joints are common. We are presenting the case of 42 year old lady who presented to our unit with retro-sternal thyroid for surgery who was on physical examination found to have proximal symphalangism in bilateral hands and feet. She however reported similar condition in her father with associated absence of finger nails in all the fingers. She did not complain of any functional impairment in daily activities and hence did not seek any intervention to regain movement, however on further clinical evaluation she was found to have associated hearing impairment. The authors are not aware of any previously reported cases of symphalangism in Nigeria. This case is presented to alert clinicians of its existence and possible association with other abnormalities. STEREOTACTIC RADIO SURGERY (SRS) FOR ARTERIOVENOUS MALFORMATIONS (AVM): A PROTOCOL BASED ON THE SIZE, LOCATION AND RISKS OF RADIONECROSIS B G Ratnam, Rahul Lath, Alok Ranjan. Department of Neurosurgery, Apollo Health City, Hyderabad, India 500033. Abstract Objective: To review the results and complications of patients undergoing stereotactic radiosurgery (SRS) for AVM's. Methods: Data was collected prospectively for all patients undergoing SRS for AVM's at our institution from May 2010. Small volume AVM's were treated with a single fraction SRS while large volume AVM's and AVM's in areas with high risk of radionecrosis were treated with hypofractionated SRS. Radiological follow up with MRI was done at 6 months, 1 year, 2 years and then annually. Digital Subtraction Angiography was planned at the end of 3 years. Results: Twenty five patients (12 male and 13 female) underwent SRS. Single fraction SRS was done for 13 patients while hypofractionated SRS was done in 12. The age group was from 10 to 58 years. The AVM volume in the single fraction group ranged from 1 cc to 11.3 cc, while in the hypofractionated group it ranged from 10.7 cc to 31 cc. The marginal doses in the single fraction group were from 16 Gy to 20 G. The hypofractionated group received a marginal dose ranging from 6 to 7 Gy per fraction X 5 fractions. Symptomatic perilesional edema requiring steroids was seen in 1 patient in the single fraction SRS group and in 3 patients in the hypofractionated group. Conclusions: Single fraction SRS is suitable for small volume AVM'swhilelargevolume AVM'sand AVM'sinareaswithhighrisk ofradionecrosiscanbesafelytreatedwithhypofractionation. EPIDEMIOLOGICAL PATTERN AND MANAGEMENT OUTCOME OF SPINAL INJURIES IN IBADAN, NIGERIA A A. ADEOLU1,2, AK. UKACHUKWU2, JA. BALOGUN2, AO. ADELEYE1,2, AO. MALOMO1,2, MT. SHOKUNBI1,2 1Department of Surgery, College of Medicine, University of Ibadan, and 2Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria. Presenter: Dr. A K. Ukachukwu E-mail:  HYPERLINK "mailto:dr_alvan@yahoo.com" \h dr_alvan@yahoo.com Phone numbers: +234 816 733 5934 or +234 812 081 6973 Abstract BACKGROUND: The epidemiology and management of spinal injuries (SI) are still evolving in our sub-region. This study aims to outline the epidemiological pattern and management outcome of SI seen in our centre. Methods: We prospectively obtained data from all patients who presented with SI from 2009 to date. The data include the patients' demography, duration of injury, aetiology, Frankel grade at admission and discharge, nature of injury, and type of definitive treatment. Primary outcome was change in Frankel grade at admission and discharge categorized as same, improved or worse. Results: Four hundred and ten patients (male: female= 2.8:1; age range 4-80 years; mean age 38.413.7 years) have been managed so far. The injury occurred mostly (23.8%) in business men/women while 2.8% were farmers. Only39.6% presented on the same day of trauma while 13.5% presented a week after trauma. Road traffic crashes accounted for 72.4%, falls 21.2%, and gunshot injuries 1.9%. The regions involved were upper cervical: 7.6%, subaxial cervical:61%, thoracic:17.2%, thoracolumbar:3.8%, lumbar:7.6%, lumbosacral:1%, multiregional:1.8%. Subluxations accounted for 37.7%, dislocations 2.4%, burst fractures 12.2%, wedge fractures 8.3%, hangman/odontoid fractures 6.8%, compression fractures 3%, and 2.4% had multiple spinal injuries. Treatment was non-operative in 85.8% and operative in 14.2%. The Frankel grading on admission was grade A: 41.8%, B:14.2%, C:5.3%, D:21.3% and E:17.4%. On discharge, the grades were: A:39.1%, B:9.3%, C:10.6%, D:13.7% and E: 27.3%. The neurologic status remained same in 79.4%, improved in 20% and worsened in 0.6%. Conclusion: Spinal injuries occur mostly in young male individuals in our practice and majority was due to road traffic crashes. Most were managed non-operatively, and their neurologic status remained mostly the same. 100 CASE PRESENTATION- ENDOSCOPIC REPAIR OF A ENCEPHALO-MENINGOCOELE: HOW I DO IT. Anthony O Owa, Rhiyoma M.Ogadako Josselyne Tedajo Correspondence: Dr Anthony Owa Queen's Hospital, Barking, Havering and Redbridge University Teaching Hospital NHS Trust, Romford, U.K. (Currently on sabbatical at the ENT Department, Lagos State University Teaching Hospital Abstract Video case Presentation of the management of a 63-year-old Caucasian with a spontaneous CSF leak due to an encephalo- meningocoele. Patient had initially been wrongly diagnosed as having rhinosinusitis based on the radiology report prior to a further review prior to surgical intervention. Pitfalls in management is discussed. Methods: Medical records including the video of the surgery was reviewed post operatively. Results: No CSF leak to date and patient is asymptomatic. Conclusion: Endoscopic repair of a meningocoele is a viable tool in the management of this lesion. The fact that it is an entirely extra-dural trans nasal approach makes it a better option compared to trans-cranial approach necessitating a craniotomy which carries a greater morbidity and mortality. OUTCOME OF CLOSED REDUCTION OF CERVICAL SPINE INJURIES IN IBADAN, NIGERIA A A. ADEOLU1,2, A K. UKACHUKWU2, G I. OGBOLE3, A O. MALOMO1,2, M T. SHOKUNBI1,2 1Department of Surgery, College of Medicine, University of Ibadan, and 2Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria. 3Department of Radiology, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria. Correspondence/Presenter: Dr. AK. Ukachukwu E-mail:  HYPERLINK "mailto:dr_alvan@yahoo.com" \h dr_alvan@yahoo.com Phone numbers: +234 816 733 5934 or +234 812 081 6973 Abstract Background: Only few studies have evaluated the effectiveness and complications of closed reduction of Cervical Spine Injuries (CSI). Thus, this study was designed to determine the effectiveness, outcome and complications of closed reduction of CSI using Gardener-Wells Tongs (GWT) traction. Methods: This is an on-going prospective study of CSI managed by closed reduction using GWT from February 2012 in our centre. The data included duration of injury, Frankel grade before and after traction, nature of injury, reduction weight, extent of reduction, and reasons for incomplete reduction. Reduction up to 95% or more was deemed as satisfactory. Primary outcome was extent reduction, while the secondary outcome was change in Frankel grading after reduction. Results: Sixty-nine patients (45 male: 24 female; mean age 36.9+/- 11.9 years) were included in the study. Most of the patients (82.5%) presented within 72 hours of injury. Majority (81.3%) were involved in road traffic crashes. Anterior subluxation was seen in 76.8%. The degree of displacement was <25% in 39.6%, 25-50% in 30.2%, >75% in 17%, 50-75% in 11.3%, and no displacement in 1.9%.Traction-reduction was done after 7 days of injury in 41.3%, 4-7 days in 31.7%, 1-3 days in 17.5%, and 9.5% had no attempt at reduction. Reduction weight ranged from 2kg to 60kg (mean and mode 21-30kg). Reduction was satisfactory in 70.5% and failed in 6.6%.Failed/incomplete reduction was due to facet lock in 57.1%, old injury in 23.8%, new-onset/worsening pain in 14.3%, and over-distraction in 4.8%.Complications of closed reduction were over-distraction in 4.3%, and 2.9% each due to pin pull-out and new-onset/worsening pain. 88.1% remained neurologically same after traction, while 11.9% improved. Conclusion: Satisfactory reduction is feasible with GWT traction in many of our patients with CSI and significant mal- alignment. The method is associated with few complications. MALE PARTNER INVOLVEMENT IN MATERNITY CARE IN ABLEKUMA SOUTH DISTRICT, ACCRA, GHANA. Roseline D Doe. Abstract BACKGROUND: In settings where men play key role in decision making in the household, some women's access to and utilisation of health service is influenced by their partners. Male involvement in maternity care is one key strategy that can be used to accelerate the decline in maternal mortality in Ghana. OBJECTIVE: The objective of this study, conducted in Ablekuma South District of Ghana was to determine the level of male partner involvement in maternity care and identify factors that influenced their involvement. METHODS: A cross-sectional survey was conducted among 422 men aged 18 years and above with children 5 years and below. The survey was complemented by 4 focus-group discussions. Male involvement was measured using a composite measure of 5 key points. RESULTS: The mean age of participants was 32.9years (SD=8.2). Overall, 26.4%, 55.2% and 18.4% had high, moderate and low level of involvement. Higher level of education and the couple living together (OR= 13.12, 95%CI 6.86, 25.08) positively influenced the level of male involvement. Younger age (18-25years vs. 26-35years: OR=0.28, 95%CI: 0.12, 0.66) and the couple living with other family members had a negative influence. Healthcare institution barriers included poor staff attitudes, restricted male access to labour wards and unwelcoming environment. Social stigma associated with men playing what is perceived as feminine roles within the community was another barrier. CONCLUSION: Improving male-friendliness of health facilities and education of the community to sensitise them against the negative attitudes towards male participation in maternity care can improve male involvement. PREVALENCE OF MATERNAL MALARIA PARASITAEMIA AT TERM AMONG PREGNANT WOMEN WHO RECEIVED INTERMITTENT SULPHADOXINEPYRIMETHAMINE PREVENTIVE TREATMENT AT AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA Anate Abdullahi, Yakasai, Ibrahim Adamu. Maitama Hospital Abuja, Nigeria. Email:  HYPERLINK "mailto:abdullahianate@yahoo.com" \h abdullahianate@yahoo.com Abstract Background: Intermittent sulphadoxine pyrimethamine preventive treatment is recommended by WHO in order to prevent adverse effect of malaria in pregnancy. However, the emergence of resistance to sulphadoxine pyrimethamine in some parts of Sub Saharan Africa may have compromised its efficacy. Therefore, at this present time there is a need to evaluate the efficacy of intermittent sulphadoxine pyrimethamine preventive treatment. Aim: To determine the prevalence of maternal malaria parasitaemia at term among pregnant women who received the full doses of intermittent sulphadoxine pyrimethamine preventive treatment. 101 Methods: The study is a cross sectional study involving 704 pregnant women who met the inclusion criteria and also booked and delivered at Aminu Kano Teaching Hospital, Kano. They all received the full doses of intermittent sulphadoxine pyrimethamine preventive treatment under directly observed therapy and maternal malaria parasitaemia were checked in labour at term. Data were analysed using Minitab Statistical Software. Results: Prevalence of maternal malaria parasitaemia was 13.5%, 95% C.I. (10.2 14.7). Among those who were smear positive for malaria parasite, primigravidae constituted 66.7%, 95% C.I (64.1 68.2 ), Secundagravidae 16.7%, 95% C.I.( 15.1 17.3), Gravidae 3 5 constituted 8.3% 95% C.I.( 7.2 9.1) and Gravida 6 and above also constituted 8.3%, 95% C.I. (6.9 7.8). Conclusion: Contrary to the reported resistance to sulphadoxine pyrimethamine in some parts of Sub Saharan Africa, intermittent sulphadoxine pyrimethamine preventive treatment is still efficacious in Kano, Nigeria. INTERMITTENT PREVENTIVE TREATMENT: THE EFFECT OF ADEQUATE COUNSELING ON ITS UPTAKE AND COMPLIANCE. Anate, Abdullahi, Zakari, Muhammad. Abstract Background: WHO recommended intermittent preventive treatment with directly observed therapy, in order to enhance compliance. Today, most busy antenatal clinics that practise intermittent preventive treatment, do not practise directly observed therapy, owing to the burden and extra demands associated with it. Adequate and intensive counselling of pregnant women on the importance of intermittent preventive treatment during antenatal clinics may equally enhance uptake and compliance thereby sparing busy antenatal clinics the burden and extra demands associated with the practice of directly observed therapy. The aim of the study is to determine the uptake and compliance of intermittent sulphadoxine pyrimethamine preventive treatment of women who booked and delivered at Aminu Kano Teaching Hospital, Kano. Methods: The study is a cross-sectional study involving 1,032 pregnant women who fulfilled the inclusion criteria and also booked and delivered at Aminu Kano Teaching Hospital, Kano. At booking during the routine health talks, they were intensively counseled on the importance of intermittent preventive treatment. Also at the point of dispensing sulphadoxine pyrimethamine to each one of them, the needs for the drug and compliance were equally re emphasized. Subsequently, they were allowed to have intermittent preventive treatment with self administered therapy. Interviewer administered questionnaire were administered at delivery to determine the uptake and compliance. Data were entered into Minitab Statistical Software and analyzed. Results: The uptake of sulphadoxine pyrimethamine for the two doses was 96.5%, 95% C.I. (94 97.4). The uptake of sulphadoxine pyrimethamine for the first dose was 98.5%, 95% C.I. (96 99.1) while the uptake of sulphadoxine pyrimethamine for the second dose was 92.7%, 95% C.I. (90.2 94.4). Conclusion: At Aminu Kano Teaching Hospital, Kano, following adequate and intensive counseling uptake and compliance of intermittent preventive treatment with self administered therapy was satisfactory; and as such, intermittent preventive treatment with directly observed therapy may not be necessary FACTORS INFLUENCING UTILIZATION OF ANTENATAL CARE SERVICES AND DETERMINANTS OF PLACE OF DELIVERY IN URBAN GHANA - THE CASE OF KUMASI METROPOLIS Opare-Addo H S, Acheampong F, Emmanuel Nartey, Adomako-Boateng F, Dassah E T. Correspondence: Prof H S Opare-Addo, Department of Obstetrics and Gynaecology, Komfo Anokye Teaaching Hospital E-mail:  HYPERLINK "mailto:sopareaddo@gmail.com" \h sopar HYPERLINK "mailto:eaddo@gmail.com" \h eaddo@gmail.com Abstract Objective: To determine factors influencing utilization of antenatal care services and place of delivery in Kumasi Metropolis Methods: A community-based cross-sectional study conducted in March 2013 among Ghanaian women resident in Kumasi Metropolis who delivered within two years prior to the study. Multistage sampling techniques were used to select participants from the five sub-metros. Data were analysed using 2, Fisher's exact and student t-tests. Factors associated with utilization of antenatal care services and places of delivery were examined using logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant. Results: Overall, 487 women were recruited into the study; 90% received antenatal care and 85% had supervised deliveries. Women of at least 20 years of age, married women, women or husbands with some formal education as well as women who had had 2-4 deliveries were more likely to have received antenatal care or had supervised delivery compared to their teenage, single, none-educated, and primiparous or grandmultiparous (parity e" 5) counterparts respectively. Women who were supported by their partners during pregnancy were more likely to utilize antenatal care services (OR 5.51; 95% CI 2.78-10.98). Majority (71.6%) of the women considered the attitude of health care workers to be good- excellent. Cost of services and waiting time at the clinic were not significant barriers to seeking antenatal care or institutional delivery services. Conclusion: Improving female education, encouraging partner support during pregnancy as well as previous birth experiences are likely to improve antenatal care and institutional delivery rates. WHY GHANA'S NEONATAL MORBIDITY AND MORTALITY RATES MAY NOT BE REDUCED WITHOUT THE RIGOROUS AND SKILLFUL USE OF CLINICAL ULTRASOUND Sam N. Ofori Lister Hospital & Precision Healthcare, Accra, Ghana. Abstract Background: There is a substantiated conviction among clinicians that the assessment of fetal size using the symphysis fundal height alone is less sensitive and should be completed by ultrasound fetal weight estimation (McKenna et al, 2003; Nasser et al, 2006; Madruzzato, 2008) and Doppler ultrasound known to help reduce perinatal deaths (Nicolaides et al, 2002; Lakhkar et al, 2006). The aim of this survey was to investigate whether Ghana's Healthcare facilities have protocols in place to guide Healthcare professionals (HCP) performing obstetric ultrasound and whether these HCP's have the requisite training and appropriate equipment to assess fetal wellbeing. Methods: A detailed survey was carried out in 179 (71%) of Hospitals and Clinics in Ghana between May 2011 and November 2013, by interviewing HCP's in these facilities, and assessing and recording the capacity of their ultrasound equipment. 102 Results: Of the health facilities studied, approximately 90% were found to lack personnel with in-depth obstetric ultrasound knowledge and appropriate ultrasound equipment nor did they have any obstetric ultrasound protocol to guide users on the timing of examinations, what to look for during an obstetric examination and what each finding could mean for patient care. Conclusion: This study showed that obstetric ultrasound practice in Ghana is poor. The most serious implication for obstetric care from this survey is that fetal growth, biophysical profile and Doppler assessment of the maternal-fetal circulation crucial to identifying those fetuses at risk of dying in utero is not performed in many centers. AN IDEAL MESH FOR HERNIA REPAIR *Stephen Tabiri, **M. Ohene-Yeboah, **F.A. Abantanga *Tamale Teaching Hospital, School of Medicine and Health Sciences, University for Development Studies and Ghana Hernia Society **Komfo-Anokye Teaching Hospital, School of Medical Sciences, KNUST and Ghana Hernia Society Abstract Background Effective repair of hernia is a difficult task. There have been many advances in hernia repair techniques over the past 50 years, but new strategies must be considered to enhance the success of herniorrhaphy. Discussion: At the 30th International Congress of the European and American Hernia Societies, nine experts in hernia repair and experimental mesh evaluation participated in a roundtable discussion about today's unmet needs in hernia repair, including what constitutes an ''ideal'' hernia repair and the portfolio of ''ideal'' mesh prostheses. Defining characteristics of lightweight mesh, mesh alternatives, the surgeon's role in hernia repair, adverse events, the unmet requirements for today's hernia repair, and optimized animal models were among the topics discussed. Conclusion: The ideal mesh's construction is still in progress, but greater understanding of its critical characteristics was explored. Based on this we recommend Vipro mesh (light weight mesh) for hernia repair. UN MAILLAGE IDEAL POUR LA REPARATION DES HERNIES RESUME FOND La rparation effective de la hernie est une tche difficile . Il ya eu de nombreuses avances dans les techniques de rparation hernie au cours des 50 dernires annes, mais de nouvelles stratgies doivent tre envisages pour renforcer le succs de herniorraphie . DISCUSSION Au 30e Congrs international des socits europennes et amricaines hernie , neuf experts de rparation des hernies et de l'valuation de maille exprimental ont particip une table rondesurlesbesoinsnonsatisfaitsd'aujourd'huidanslarparation deshernies, ycompriscequiconstitueun'' idal'' larparationdes hernies et le portefeuille de '' idal '' maille prothses . Dfinir les caractristiques de maille lgre , des alternatives de maille , le rle du chirurgien dans la rparation des hernies , les effets indsirables , les exigences non satisfaits pour la rparation de hernie aujourd'hui , et des modles animaux optimiss ont t p a r m i l e s s u j e t s a b o r d s . CONCLUSION: La construction de la maille idale est toujours en cours , mais une meilleure comprhension de ses caractristiques essentielles a t explore . Sur la base de ce que nous recommandons maille Vipro ( poids lger de maille ) pour la rparation des hernies . CHRONIC PAIN POST MESH REPAIR OF INGUINAL HERNIA: LITERATURE *Abantanga F.A., **Tabiri S., *Ohene-Yeboah M. *Department of Surgery, Komfo-Anokye Teaching Hospital, School of Medical Sciences, Kwame-Nkrumah University of Science and Techonology, Kumasi-Ghana and Ghana Hernia Society **Department of Surgery, Tamale Teaching Hospital, School of Medicine and Health Sciences, University for Development Studies, Tamale-Ghana and Ghana Hernia Society Abstract Inguinodynia (chronic groin pain) is one of the recognised complications of the Lichtenstein mesh inguinal hernia repair. This has major impact on quality of life in a small proportion of patients. The pain is classified as neuropathic and non- neuropathic related to nerve damage and to the mesh, respectively. Correct diagnosis of this problem is relatively difficult. A thorough history and clinical examination are essential, as is a good knowledge of the groin nerve distribution. The literature evidence on chronic pain is limited. In this paper we discuss the diagnostic tools and treatment options, both non-surgical and surgical. In addition, we discuss the criteria for surgical intervention and its optimal timing. rsum Inguinodynia (Douleur chronique l'aine ) est l'une des complications reconnues du Lichtenstein maille cure de hernie inguinale . Cela a un impact majeur sur la qualit de la vie dans une petite proportion de patients. La douleur neuropathique est class et non neuropathique associe des lsions nerveuses et la maille, respectivement. Un diagnostic correct de ce problme est relativement difficile. Une anamnse et un examen clinique sont essentiels, tout comme une bonne connaissance de la distribution aine de nerf . La preuve de la littrature sur la douleur chronique est limite. Dans cet article, nous discutons des outils de diagnostic et les options de traitement, la fois non - chirurgical et chirurgical . En outre, nous discutons les critres d'intervention chirurgicale et son moment optimal. RESULTS OF TENSION FREE MESH HERNIA REPAIR IN GHANA *Tabiri Stephen, **Ohene-Yeboah Michael, **Abantanga Francis, **Dally Charles *Department of surgery, Tamale Teaching Hospital, School of Medical and Health Sciences, University for Development Studies and Ghana Hernia Society **Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame-Nkrumah University of Science and Technology Abstract Background: Hernias remain an important surgical condition. Randomize trial comparing the outcomes after herniorrhaphy with suturing, tension free (tissue-base and mesh) techniques is needed Methods: A total of 183 male and 21 female patients were randomized to undergo either suture repair of hernias or tension free repair. The primary outcomes measured were complications; recurrence and early return to normal activities post surgery and long term complications 103 Results: Early complications: scrotal haematoma observed in 4 patients in the mesh group, 2 patients in the suturing group and 1 patient in the Desarda arm. Immediate postoperative pain observed in 4.8%, 1.2%,1% in suturing repair, Mesh repair and Desarda technique respectively (p<5). Seroma was less in both the suturing and Desarda repair (p>5). Tension free repair patients return to normal activities earlier than suturing. Hernia recurred in 6.3% patients in suturing and in 1.1% patient in mesh group at one year follow-up Conclusions: Tension free methods of repair has better outcome comparing to suturing repair in terms of recurrence, early return to normal activities and early postoperative pain RESULTATS DE TENSION EN MESH REPARATION DES HERNIES AU GHANA Fond: Hernies restent une condition chirurgicale importante. Objectifs: Alatoire essai comparant les rsultats aprs herniorraphie avec suture , sans tension ( tissu de base et mesh techniques Mthodes: Un total de 183 21 patients masculins et fminins ont t randomiss pour subir une rparation par suture des hernies ou tension rparation gratuite . Les principaux rsultats ont t mesurs complications ; rcidive et retour rapide aux activits normales aprs la chirurgie et long terme des complications Rsultats Les complications prcoces: hmatome scrotal observe chez 4 patients dans le groupe de mailles , deux patients dans le groupe de suture et 1 patient dans le bras Desarda . Douleur postopratoire immdiate observe chez 4,8 % , 1,2% , 1 % dans la rparation de suture , Mesh technique de rparation et Desarda respectivement ( p < 5 ) . Srome tait moins la fois la suture et Desarda rparation ( p> 5 ) . Tension libre patients de rparation reprendre leurs activits normales plus tt que la suture. Hernie rcidiv dans 6,3 % des patients dans suture et chez 1,1% des patients dans le groupe de maille un an de suivi Conclusion: Tension libre mthodes de rparation a de meilleurs rsultats comparant suture rparation en termes de rcidive , le retour rapide aux activits normales et la douleur postopratoire prcoce SURGICAL SITE INFECTION IN PATIENTS UNDERGOING OPEN MESH REPAIR OF INGUINAL HERNIA: A META-ANALYSIS META-ANALYSIS *Ohene-Yeboah, *Abantanga F.A., **Tabiri S., *Dally Charles *Department of Surgery, Komfo-Anokye Teaching Hospital, School of Medical Sciences, Kwame-Nkrumah University of Science and Techonology, Kumasi-Ghana and Ghana Hernia Society **Department of Surgery, Tamale Teaching Hospital, School of Medicine and Health Sciences, University for Development Studies, Tamale-Ghana and Ghana Hernia Society Abstract The use of antibiotic prophylaxis in hernia repair is still under debate. The aim of this meta-analysis was to assess the effect of antibiotic prophylaxis in patients undergoing open mesh repair of inguinal hernia with respect to incidence of postoperative surgical site infection (SSI). A literature search was conducted in databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Study selection, data extraction, quality assessment, and meta-analysis were conducted according to the recommendations by Cochrane collaboration. Nine randomized controlled trials were included. Incidence of surgical site infection was 39/1642 (2.38%) in the antibiotic group and 70/1676 (4.18%) in the control group. Antibiotics showed a protective effect in preventing SSI after mesh inguinal hernia repair (odds ratio: 0.61, 95% confidence interval: 0.40-0.92, I(2): 0%). Antibiotic prophylaxis did reduce the incidence of SSI in hernia patients undergoing mesh hernioplasty. The cost effectiveness of antibiotic prophylaxis needs further evaluation. INFECTION DU SITE OPERATOIRE CHEZ LES PATIENTS SUBISSANT MAILLES OUVERTES REPARATION DE HERNIE INGUINALE: UNE META-ANALYSE - META-ANALYSE rsum L'utilisation de l'antibioprophylaxie dans la rparation des hernies est encore en dbat . L'objectif de cette mta-analyse tait d'valuer l'effet de l'antibioprophylaxie chez les patients subissant la rparation ouverte de maille de hernie inguinale par rapport l'incidence de postopratoire infection du site opratoire (ISO). Une recherche documentaire a t effectue dans les bases de donnes MEDLINE, EMBASE, et Cochrane Central Register of Controlled Trials. Slection des tudes, de l'extraction de donnes, valuation de la qualit, et une mta- analyse ont t effectus selon les recommandations de la collaboration Cochrane. Neuf essais contrls randomiss ont t inclus . Incidence de l'infection du site opratoire tait 39/1642 (2,38 %) dans le groupe des antibiotiques et 70/ 1676 (4,18 %) dans le groupe tmoin. Les antibiotiques ont montr un effet protecteur dans la prvention de SSI aprs maille cure de hernie inguinale (odds ratio : 0,61, intervalle de confiance 95 %: 0,40 0,92 , I (2) : 0 % ) . Antibioprophylaxie fait de rduire l'incidence de la SSI chez les patients subissant une hernie maillage hernioplastie. Le rapport cot-efficacit de l'antibioprophylaxie doit valuation plus pousse. DOUBLE CAECUM AND DOUBLE APPENDIX - CASE REPORT Glover-Addy H, Hesse A.A.J, Amponsah G, Appeadu-Mensah W, Etwire V, Aboagye S All of Department of Surgery and Anaesthesia of the University of Ghana Medical School Korle-Bu Accra Correspondence: H. Glover-Addy E-mail:  HYPERLINK "mailto:hopelove12001@yahoo.com" \h hopelove12001@yahoo.com Abstract Anomalies of the appendix are rare and may be an occasional finding in adult laparotomy. We describe type C appendix duplication in a neonate with anorectal malformation, vertebral and genitourinary anomalies. CAECUM ET APPENDICE-ETUI DOUBLE DOUBLE: H Glover- Addy, Hesse A.A.J, Amponsah G, W Appeadu-Mensah, Alain V, Aboagye S All du dpartement de chirurgie et anesthsie de l'Universit de Ghana mdical scolaire Korle-Bu, Accra. C o r r e s p o n d a n c e : H . G l o v e r - A d d y E - m a i l :  HYPERLINK "mailto:hopelove12001@yahoo.com" \h hopelove12001@yahoo.com Anomalies abstraites de l'appendice sont rares et peuvent tre une conclusion occasionnelle en laparotomie adulte. Nous dcrivons type duplication annexe C chez un nouveau-n avec une malformation ano-rectale, des anomalies vertbrales et gnito-urinaires. SITUS INVERSUS ABDOMINALIS AND DUODENAL STENOSIS CASE REPORTS Glover-Addy H, Appeadu-Mensah W, Hesse A A J, Etwire V, Ghartey, Osei-Nketiah S, Oppon Ambe Paediatric Surgery Unit. Korle-Bu Teaching Hospital, Accra, Ghana. Correspondence: Hope Glover-Addy E-mail:  HYPERLINK "mailto:hopelove12001@yahoo.com" \h hopelove12001@yahoo.com Abstract Duodenal atresia and stenosis are very common types of gastrointestinal obstruction in neonates and infants. Cardiac anomalies are fairly common with this obstruction. We present a neonate and an infant with situs inversus, malrotation and cardiac anomaly as additional anomalies to the duodenal obstruction. SITUS INVERSUS ABDOMINALIS ET STENOSE DUODENALE Glover-Addy H, W Appeadu-Mensah, Hesse AAJ, Alain V, Ghartey, Osei-Nketiah S, Oppon Ambe tous de l'unit de chirurgie pdiatrique. Hpital universitaire Korle-Bu, Accra, Ghana. C o r r e s p o n d a n c e : H o p e G l o v e r - A d d y E - m a i l :  HYPERLINK "mailto:hopelove12001@yahoo.com" \h hopelove12001@yahoo.com Rsum Duodnal atrsie et stnose sont trs communs types d'obstruction gastro-intestinale chez les nouveau-ns et les nourrissons. Les anomalies cardiaques sont assez communs avec cette obstruction. Nous prsentons un nouveau-n et un enfant avec situs inversus, malrotation et anomalie cardiaque, anomalies supplmentaires l'obstruction duodnale. FOUR-YEAR REVIEW OF INTUSSUSCEPTIONS IN KORLE-BU TEACHING HOSPITAL Glover-Addy H, Hesse A A J, Appeadu-Mensah W, Etwire V, Boateng Mensah Y Abstracts Background: Intussusception is the most common cause of intestinal obstruction in infants. Most patients in developed countries report early for treatment. In developing countries patients report to primary care institutions early but diagnosis are made late and hence relatively high mortality. This study reviewed intussusception over a 4-year period in Korle-Bu teaching hospital. Methods: Children with intussusceptions were studied in a prospective manner from the period of August 2004 to October 2009. The research looked the time it takes for patients to report to a health institution and the time taken to make a diagnosis. The data was crossed checked with ward register to delete any ambiguity and analysed. Results: A total of 157 patients were studied out which 63.7% were males and 36.3% were females. The peak incidence was 6- 10 months. The common symptoms in day 1 were vomiting (108) FOLLOWED by COLICS (100). Mortality increased 21.4% on day 3 as against an average of 1.23% on day 1 and2. Less than 50% were diagnosed day 1 of the disease. The ease of fluid reduction was highest at day1.patients without fever had the earliest discharge. Conclusion: Early diagnosis and management of intussusception is theprerequisiteforgoodprognosisandreductioninmortality. L'EXAMEN DE 4 ANS DE L'INTUSSUSCEPTION DANS L'HOPITAL D'ENSEIGNEMENT DE KORLE-BU L' AUTEURS: Glover-Addy H, Hesse AAJ, Appeadu-MensahW, Etwire V, Boateng Mensah FOND : L'Intussusception est la plupart de cause classique d'obstruction intestinale dans les nourrissons. La plupart des patients dans les pays dvelopps se plaignent tt pour le traitement. Dans les pays en dveloppement, les patients font rapport aux tablissements de premier soins tt mais le diagnostic sont faits la mortalit tard et par consquent relativement leve. Cette tude a pass en revue l'intussusception sur une priode de quatre ans dans l'hpital d'enseignement de Korle-Bu. Matriaux et Mthode : Des enfants qui sont suffire intussusceptions ont t tudis d'une faon ventuelle de la priode des aot 2004 octobre 2009. La recherche a regard le temps o elle prend pour que les patients fassent rapport une institution de sant et au temps pris pour faire un diagnostic. Les donnes ont t croises ont vrifi avec le s'inscrire de salle pour supprimer n'importequelle ambigut et ont analys. Rsultats : un total de 157 maladies ont t tudies que 63.7% taient des males et 36.3% taient des femelles. L'incidence maximale tait de 6-10 mois. Les symptmes communs dans le jour 1 taient vomissement (108) suivi par des coliques abdomens(100). La mortalit a augment 21.4% le jour 3 par comparaison avec une moyenne de 1.23% les jours 1 et 2. Moins de 50% ont t diagnostiques le jour 1 de la maladie. La facilite de la rduction liquide tait la plus haute a le premier jour. Maladie sans fivre a eu la dcharge la plus tt. Conclusion : Le diagnostic prcoce de l'intussusception est le pralable au bon pronostic et rduction de mortalit. FIVE YEARS PROSPECTIVE OUTCOME ANALYSIS OF THE MANAGEMENT OF INTESTINAL ATRESIA IN KORLE' BU TEACHING HOSPITAL: CAN THE PRESENT AFFECT THE FUTURE? H. GLOVER-ADDY, A.A.J. HESSE, W. APPEADU-MENSAH, V. ETWIRE, S. OSEI-NKETIAH, A. A. ADEDAYO, A. OBBENG. Paediatric Surgery Unit, Department of Surgery, Korle' Bu Teaching Hospital, Accra, Ghana. Abstract BACKGROUND: Intestinal Atresia is the commonest congenital cause of small bowel obstruction. Surgery is the mainstay of treatment. We present our 5-year experience in the management of intestinal atresia. The aim is to review the outcomes of management of intestinal atresias in Korle-Bu Teaching Hospital. METHODS: A prospective review of neonates presenting with Intestinal atresias to the Paediatric Surgery Unit of the Korle-Bu Teaching Hospital, Accra, over a 5 year period (January 2008 to December 2012). Data were entered into a structured proforma for each child. Data entered into proforma was analyzed accordingly using SPSS version 17. Significant testing was carried out using Chi-Square for categorical variables and Students't-Test for continuous variable. P value of <0.05 was taken as significant. RESULTS: A total of 57 patients were enrolled into the study, 25(56%) were male and 32(44%) were female. Weight at presentation ranged from 1.4 -3.5kg, with an average weight of 2.6kg. The majorities were diagnosed in the postnatal period; prenatal diagnosis was made in only 4 (7%) cases. Diagnoses were made commonly in the secondary and tertiary health institution (36.9% and 50.9% respectively). Affected neonates were seen at the PS unit, mostly on the fourth day of life. Bilious vomiting was the most consistent symptoms (93%) at presentation. Other presenting symptoms were abdominal distension (42%), non passage of meconium (44%). Associated congenital anomalies were found in 9(15.8%) cases. Haemoglobin concentration was normal (13-18g/dl) in 42 (80.8%) of cases. In sixteen (28%) patients, blood transfusion was inevitable. Twenty-six (30.2%) had the double-bubble appearance on X-ray. Seven (21.3%) had asymptomatic hyponatraemia that was duly corrected. Post-ampullary obstruction was found in 84% of cases. Bowel length ranged from 50cm-400cm. Average functional bowel length was found to be 128cm. Bowel resection was done in 34 (59.6%) of cases. Feeding was commenced between 2 -3 weeks in post operative period; an average time was 2 weeks in the post-operative period. 33 (57.9%) had persistent vomiting for 2 weeks after commencement of feeds. There was no statistically significant weight gain after 4 weeks hospital stay with feeding. The commonest complication found was septicaemia accounting for most of the mortalities recorded. Forty patients (70.2%) were discharged home after an average hospital stay of 3 weeks. We recorded 17 (29.8%) mortalities. Only 20 (35.1%) patients were available for follow up at time of analyzing this review. CONCLUSION: Management of patients with Intestinal atresia still poses tremendous challenges in our setting. Mortality and morbidity can still be reduced to a bare minimum through a concerted multidisciplinary approach and a well orchestrated healthcare system. Targeted prenatal evaluation is still lacking in our environment. Improved prenatal evaluation will make tremendous impact in prognosis and should be aimed at, for a better future. KEYWORDS: Intestinal atresia, Pre- natal diagnoses, Congenital anomalies. CINQ ANS D'ANALYSE VENTUELLE DES RSULTATS DE LA GESTION DE L'ATRSIE INTESTINALE AU CENTRE HOPITALIER UNIVERSITAIRE DE KORLE-BU : PEUT- LE PRSENT INFLUENCER L'AVENIR ? H. GLOVER-ADDY, A.A.J. HESSE, W. APPEADU-MENSAH, V. ETWIRE, S. OSEI-NKETIAH, A. A. ADEDAYO, A. OBBENG. De: Unit pdiatrique de chirurgie, hpital universitaire de Korle-Bu, Accra, Ghana. ABSTRACT FOND : L'atrsie intestinale est la cause la plus commune de la petite obstruction d'entrailles congnitale. La chirurgie est le soutien principal du traitement. Nous prsentons notre exprience de cinq ans de la gestion de l'atrsie intestinale. BUTS ET OBJECTIFS : La revue des rsultats de la gestion de l'atrsie intestinale dans l'hpital Universitaire de Korle-Bu. MATRIAUX ET MTHODES : Un examen des dossiers des enfants prsentant avec l'atrsie intestinale couvrant une priode de 5 ans (janvier 2008- dcembre 2012), au Centre universitaire de Korle-Bu, Accra. Des donnes ont t saisies selon questionnaire et ceux-ci ont t analyss en consquence utilisant la version 17 de SPSS. L'essai significatif a t effectu utilisant la 'Chi-Square' pour des variable catgoriques et le 'Students' t-Test' pour le variable continue. La valeur de P de <0.05 a t prise comme significative RSULTATS : Un total de 57 malades ont t inscrit dans l'tude. 25 (56%) taient males et 32 (44%) taient de femelles. Les poids la prsentation se sont de 1.4kg 3.5kg. Un poids avr de 2.6kg. La plupart des enfants se prsents pendants la priode postnatale. Le diagnostic prnatal a t fait dans 7 (12.3%) lo cas. La plupart des enfants affectes ont t vus aux 4 jours de vie. Des diagnostics ont t faits gnralement l'institution de sant secondaire et tertiaire (36,9% et 50,9% respectivement).Le vomissement bilieux tait les symptmes les plus cohrents (93%) prsentation. Des anomalies congnitales associes ont t trouves dans 9 (15.8%) cas. La concentration en hmoglobine taient 13-18g/dl de 42(80.8%) cas. La transfusion du sang est t invitable dans 16 (28%) du cas. 'Double-bubble' sur le rayon X a t seulement trouve dans 26 (30.2%) des cas. Sept (21.3%) ont eu l'hyponatrmie asymptomatique. L'obstruction courrier- ampullaire a t trouve dans 84% du cas. La longueur d'entrailles s'est tendue de 50cm-400cm. La longueur moyenne d'entrailles s'est avr 128cm. La rsection d'entrailles a t faite dans 34 (59,6%) du cas. L'alimentation a t dbute aprs 2 semaines. Trente-trois (57,9%) ont eu le vomissement persistant pour 2 semaines aprs commencement des alimentations. Gain de poids statistiquement significatif aprs l'hpital 4 semaines ne reste pas avec l'alimentation. La complication la plus commune tait septicmie expliquant la plupart des mortalits. Quarante (70,2%) taux de survie et dix-sept (29,8%) taux de mortalit ont t enregistrs. Seulement, 20(35.1%) malades ont taient disponible pour le suivi a la fin de cetterevue. CONCLUSION: Prsentant l'atrsie intestinale lance toujours degrands dfis dans notre arrangement. La mortalit et la morbidit peuvent encore tre rduites au strict minimum par un systme de sante bien orchestre, ajoute une approche pluri discipline concerte. Le diagnostic prnatal peut amliorer le rsultat de ce problme congnital. MOTS-CLS: Atrsie intestinale, diagnostique prnatal, anomalies congnitales. DOUBLE BLIND RANDOMIZED TRIAL ON COMPARISON OF PROPHYLACTIC INTRAMUSCULAR ERGOMETRINE AND OXYTOCIN FOR PARTURIENTS IN THE THIRD STAGE aGEORGE UCHENNA ELEJE, aCHUKWUEMEKA OKWUDILI EZEAMA, bNKIRU NWAMAKA EZEAMA, aANTHONY OSITA IGWEGBE, aJOSEPH IFEANYICHUKWU IKECHEBELU, aJOSEPH ODIRICHUKWU UGBOAJA, cIFEANYICHUKWU UZOMA EZEBIALU, dAHIZECHUKWU CHIGOZIEM EKE. aDEPARTMENT OF OBSTETRICS AND GYNECOLOGY, Nnamdi Azikiwe University Teaching Hospital,Nnewi, Anambra State, Nigeria bDEPARTMENT OF COMMUNITY MEDICINE, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria cDEPARTMENT OF OBSTETRICS AND GYNECOLOGY, Anambra State University Teaching Hospital, Amaku, Awka, Nigeria. d Department of Obstetrics and Gynecology Michigan State University/ Sparrow Hospital, Lansing, MI 48912, Michigan, USA. CORRESPONDING AUTHOR: DR ELEJE GEORGE UCHENNA; DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, Nnamdi Azikiwe University Teaching 106 Hospital, Nnewi, PMB 5025, NNEWI, ANAMBRA STATE, NIGERIA Phone=: +2348068117444; E Mail=  HYPERLINK "mailto:georgel21@yahoo.com" \h georgel21@yahoo.com CATEGORY: IMPROVING Maternal and Child Health. Clinical trial registry: Pan African Clinical Trial Registry (www.pactr.org): 201105000292708. ABSTRACT Background: Because of hazards of postpartum hemorrhage, WHO guidelines recommend oxytocin as first choice oxytocics and reverting to ergometrine if oxytocin is unavailable in the third stage of labor. Previous studies on active management of third stage of labor have focused on intravenous administration of these oxytocics. Further studies assessing the intramuscular route are necessary. Objectives: To determine the efficacy and adverse effects of intramuscular ergometrine in comparison with intramuscular oxytocin in preventing postpartum hemorrhage during 3rd stage of labor. Materials and Methods: Women with singleton pregnancies of at least 28 weeks gestation and had vaginal delivery in Nnamdi Azikiwe University Teaching Hospital Nnewi, south-east Nigeria were included. Oxytocin (10 iu) or ergometrine (0.5 mg) were administered intramuscularly in double-blinded pattern as soon as delivery of the baby. Analysis was by intention-to-treat. Results: A considerable drop in mean total blood loss (301.8109.2 mls vs 287.1 84.4 mls, P = 0.011) and packed cell volume (30.71.7% vs 31.62.0%; Z=0.00; P=0.008) was observed in parturients that received intramuscular ergometrine at the postpartum period. Rates of therapeutic oxytocics, blood transfusion, retained placenta, and manual removal of placenta were significantly high in oxytocin group. No significant differences between groups were observed in terms of adverse effects, with exception of diastolic hypertension, which was more common in ergometrine group (OR=0.00; 95%CI= 0.000.75; P=0.007). Conclusions: Intramuscular ergometrine is superior to intramuscular oxytocin in averting postpartum hemorrhage during 3rd stage of labor in Nigeria. There are no significant risks of adverse effects except diastolic hypertension. EN DOUBLE AVEUGLE ESSAI RANDOMISE SUR LA COMPARAISON DES PROPHYLACTIQUE INTRAMUSCULAIRE ERGOMETRINE ET L'OCYTOCINE POUR PARTURIENTES DANS LA TROISIEME ETAPE aGEORGE Uchenna ELEJE , aCHUKWUEMEKA Okwudili EZEAMA , bNKIRU NWAMAKA EZEAMA , aANTHONY osita Igwegbe , aJOSEPH Ifeanyichukwu IKECHEBELU , aJOSEPH ODIRICHUKWU UGBOAJA , cIFEANYICHUKWU uzoma EZEBIALU , dAHIZECHUKWU CHIGOZIEM EKE . aDEPARTMENT d'obsttrique et gyncologie de l'hpital universitaire Nnamdi Azikiwe enseignement , Nnewi , tat ?d?'Anambra , au Nigria bDepartment DE MDECINE , Hpital universitaire Nnamdi Azikiwe enseignement , Nnewi , tat ?d?'Anambra , au Nigria cDEPARTMENT d'obsttrique et gyncologie , Hpital Universitaire d'Etat d'Anambra enseignement , Amaku , Awka , Nigeria . d Dpartement d'obsttrique et de gyncologie Hpital Michigan State University / Sparrow , Lansing , MI 48912 , Michigan , USA . Auteur correspondant: DR ELEJE GEORGE Uchenna ; Dpartement d'obsttrique et de gyncologie , Universit Nnamdi Azikiwe hpital d'enseignement , Nnewi , PMB 5025 , Nnewi , tat ?d'Anambra , NIGERIA Tlphone = +2348068117444 ; Courriel =  HYPERLINK "mailto:georgel21@yahoo.com" \h georgel21@yahoo.com CATGORIE: amliorer la sant maternelle et la sant infantile . Essai clinique Registre: Registre panafricain des essais cliniques (  HYPERLINK "http://www.pactr.org/" \h www.pactr.org ): 201105000292708 . RSUM: Contexte: En raison des risques d'hmorragie du post-partum , les lignes directrices de l'OMS recommande l'ocytocine comme premiers oxytociques choix et revenir ergomtrine si l'ocytocine n'est pas disponible dans la troisime phase de travail . Des tudes antrieures sur la gestion active de la troisime phase du travail se sont concentrs sur l'administration intraveineuse de ces ocytociques . D'autres tudes valuant la voie intramusculaire sont ncessaires . Objectifs: Dterminer l'efficacit et les effets indsirables de l'ergomtrine par voie intramusculaire par rapport l'ocytocine par voie intramusculaire dans la prvention de l'hmorragie du post-partum pendant 3me tape du travail . Matriel et mthodes: Les femmes ayant des grossesses uniques d'au moins 28 semaines de gestation et ont accouchement vaginal l'Universit Nnamdi Azikiwe CHU Nnewi , au sud - est du Nigeria ont t inclus . L'ocytocine ( 10 UI ) ou ergomtrine ( 0,5 mg) administr par voie intramusculaire dans le modle en double aveugle ds la naissance du bb . L'analyse tait en intention de traiter . Rsultats: une baisse considrable en moyenne une perte de sang totale ( 301,8 109,2 de ml vs 287,1 84,4 ml, P = 0,011 ) et le volume emball de cellules ( 30,7 1,7 % vs 31,6 2,0 % ; Z = 0,00 , p = 0,008 ) a t observe chez les parturientes qui ont reu l'ergomtrine par voie intramusculaire la priode post-partum . Tarifs de oxytociques thrapeutiques , transfusion sanguine , rtention du placenta , et l'extraction manuelle du placenta tait significativement leve dans le groupe de l'ocytocine . Aucune diffrence significative entre les groupes n'a t observe en termes d'effets indsirables , l'exception de l'hypertension diastolique , qui tait plus frquente dans le groupe de l'ergomtrine( OR= 0,00 , IC 95% 0,00 0,75 = P= 0,007 ) . Conclusions: intramusculaire ergomtrine est suprieure l'ocytocine par voie intramusculaire dans la prvention des hmorragies du post-partum pendant 3me tape du travail au Nigria . Il n'y a pas de risques importants d'effets indsirables , l'exception de l'hypertension diastolique . LOW-FIDELITY SIMULATION TO TEACH ANESTHETISTS' NON-TECHNICAL SKILLS IN RWANDA Isaac Nshimyumuremyi1, Teresa Skelton2,Mukwesi1, Lauren Zolpys3, Jean Bonaventure Uwineza1,Patricia Livingston3 Institution:1Department of Anesthesia,National University of Rwanda, Rwanda; 2Department of Anesthesia,University of Toronto, Canada; 3Department of Anesthesia, Dalhousie University, Canada. Abstract Background: This pilot study investigates whether low-fidelity instructor-driven simulation can provide effective teaching of anaesthetists' non-technical skills (ANTS) in a developing world context.Anaesthesia is difficult to practice safely in the developing world where there are severe shortages of personnel, drugs, equipment and training.Non-technical skills are critical in an environment with major clinical demands, few mentors, and scarce resources.Fostering communication skills amongsthealthcareprofessionalsiscriticalforpatientsafety. Methods: Study participants were anesthesia technicians and residents working at CHUK hospital, a tertiary referral and teaching hospital in Rwanda. The study took place between 107 July 2012 and January 2013.Baseline observations were made of 20 anaesthesia providers during cesarean sections to assess non-technical skills using the established ANTS framework. After the first observation participants were randomized to either the control or intervention group. The intervention group underwent training of ANTS using low-fidelity instructor-driven simulation with debriefing. All 20 participants were then observedagain. RESULTS: The primary outcome was the overall ANTS score out of 16. Median ANTS score of the simulation group was 13.5 (11, 16) and that of the control group 8 (8, 9) and was statistically significant at p = 0.0016. Simulation participants showed statistically significant improvement in both subcategories and in the overall ANTS score compared with ANTS score prior to simulation exposure. CONCLUSION: Rwandan anaesthesia providers show an improvement in their non-technical skills in the operating room environment with as little as one teaching session using low fidelity instructor driven simulation with debriefing. Rsum Cette tude pilote examine si la simulation axe instructeur basse fidlit peut fournir un enseignement efficace des comptences non - techniques anesthsistes ( ANTS ) dans un pays en dveloppement context.Anaesthesia est difficile de pratiquer en toute scurit dans le monde en dveloppement o il ya de graves pnuries de personnel , mdicaments, du matriel et des comptences training.Non techniques sont essentiels dans un environnement avec de grandes exigences cliniques , quelques mentors , et les rares comptences de communication resources.Fostering entre professionnels de la sant est essentielle pour la scurit des patients . Mthodes: Participants l'tude taient des techniciens d'anesthsie et rsidents travaillant l'hpital CHUK , une rfrence tertiaire et de l'hpital d'enseignement au Rwanda . L'tude a eu lieu entre Juillet 2012 et Janvier 2013.Baseline observations ont t faites de 20 fournisseurs anesthsie pendant la csarienne pour valuer les comptences non techniques en utilisant le cadre de l'ANTS tablie . Aprs les premiers participants d'observation ont t randomiss pour recevoir soit le contrle ou le groupe d'intervention . Le groupe d'intervention a suivi une formation de fourmis en utilisant la simulation axe instructeur - bas - fidlit avec dbriefing . Les participants ont ensuite t observs nouveau . Rsultats: Le critre principal tait l'ANTS globale Score sur 16 . Le score mdian ANTS du groupe de simulation tait de 13,5 (11, 16) et celui du groupe de commande 8 ( 8, 9) et tait statistiquement significative p = 0,0016 . Participants de simulation ont montr une amlioration statistiquement significative dans les deux sous-catgories et dans l'ANTS score globalparrapportl'ANTSmarqueravantlasimulationexposition Conclusion: Fournisseurs d'anesthsie rwandais montrent une amlioration de leurs comptences non techniques dans l'environnement de salle d'opration avec aussi peu qu'une session d'enseignement l'aide instructeur entran simulation bassefidlitavecdbriefing. COMPARISON OF THE EFFECTS OF GENERAL ANAESTHESIA VERSUS SPINAL ANAESTHESIA ON ARTERIAL OXYGEN SATURATION OF NEWBORNS DELIVERED BY CAESAREAN SECTION. 1Braimoh F. I, 1Nwasor E. O, 2Isamade E. S Institution:1 Ahmadu Bello University Teaching Hospital, Zaria, Nigeria; 2Jos University Teaching Hospital, Jos, Nigeria Abstract Background: Given enough time, all general anaesthetic medications administered to pregnant women crosses the placenta and enter the umbilical vein. Foetal acidaemia significantly increases after spinal anaesthesia. Maternal hypotension due to administered general or regional anaesthesia is associated with acidaemia and consequently respiratory acidosis of the newborn. The study aimed at determining the effects of anaesthetic techniques i.e. general anaesthesia (G.A.) versus Spinal Anaesthesia (S.A.) on arterial oxygen saturation (spo2) of newborns, delivered by Caesarean section (c/s). Methods: A total of 104 newborns delivered by Caesarean section using either G.A. (N=52) or S.A. (N=52) were recruited for the study. Immediately after delivery, pulse oximeter probes were applied simultaneously on the right hand finger and the right toe of neonates in group I (G.A.) and II (S.A.), then Spo2 readings were taken at 1, 5, 10, 15 and 20 minutes interval. Apgar scores were assessed at 1 and 5 minutes immediately after delivery for all the neonates in both groups. Results: Patients under group I had higher prolonged induction delivery interval (64%) when compared with group II (60%). There was no important difference in neonatal Spo2 after caesarean delivery between groups I and II. Study did not find any correlation between Apgar Scores and Spo2 readings. Preductal Spo2 readings were found to be higher than postductal Spo2 with statistically significant differences The study found no important difference between induction delivery interval (I.D.I) for babies delivered using G.A. Versus Spinal Anaesthesia and neither technique is superior to another in terms of effect on Spo2 of newborns at 1, 5 and 10 minutes after delivery. There was significant difference in Spo2 readings at 15 minutes in both groups I and II with prolonged I.D.I of 15 -30 minutes. It was observed that those group I had lower Spo2 of 80-89% when compared with group II with Spo2 of 90-100% at 15 minutes interval after C/S. the difference was statistically significant. In this study all the newborn babies in both groups showed evidence of recovery from effects of G.A and S.A. by achieving maximal Spo2 of 90- 100% at 20 minutes interval after delivery. The study found no important correlation between Apgar scores Spo2 readings and the preductal Spo2 readings were significantly higher than postductal readings. Conclusion: There is no difference between IDI for babies delivered using GA or spinal and the technique of anaesthesia had no effect on the SpO2 of the neonates in the first 10 minutes of life. However GA caused a significant lowering of the SpO2 at 15 minutes. There was evidence of full recovery from anaesthetic agents by achieving maximal SpO2 of 90- 100% at 20 minutes after delivery in all the newborns delivered irrespective of the anaesthetic technique. We conclude that technique of anaesthesia has no effects on neonatal SpO2 and Apgar scores in the first 10 minutes of life. Rsum: - tant donn assez de temps , tous les mdicaments anesthsiques gnraux administrs aux femmes enceintes traverse le placenta et pntre dans la veine ombilicale . Acidose ftale augmente considrablement aprs la rachianesthsie . Maternelle hypotension due administrer une anesthsie gnrale ou rgionale est associe une acidose et une acidose respiratoire par consquent du nouveau-n . Objectif: - L'tude visait dterminer les effets des techniques anesthsiques comme l'anesthsie gnrale (AG ) par rapport la colonne vertbrale anesthsie ( SA ) sur la saturation artrielle en oxygne ( SpO2 ) des nouveau-ns , par csarienne ( c / s) . Mthodologie: Un total de 104 nouveau-ns par csarienne en utilisant soit GA ( N = 52 ) ou SA ( N = 52 ) ont t recruts pour l'tude . Immdiatement aprs l'accouchement , les sondes d'oxymtrie de pouls ont t appliques 108 simultanment sur ?le doigt de la main droite et le pied droit de nouveau-ns dans le groupe I ( GA ) et II ( SA ), puis les mesures de SpO2 ont t prises intervalle de 1, 5 , 10 , 15 et 20 minutes . Les scores d'Apgar ont t valus 1 et 5 minutes immdiatement aprs la livraison pour tous les nouveau-ns dans les deux groupes. Rsultats: - Patients sous le groupe , j'ai eu plus prolonge intervalle de livraison d'induction (64% ) en comparaison avec le groupe II ( 60 % ) . Il n'y avait pas de diffrence importante dans nonatal SpO2 aprs csarienne entre le groupe I et II . tude n'a pas trouv de corrlation entre scores d'Apgar et les mesures de SpO2 . Lectures Preductal SpO2 ont t trouvs tre plus lev que postductal SpO2 avec des diffrences statistiquement significatives L'tude n'a trouv aucune diffrence importante entre l'intervalle de livraison d'induction (IDI) pour les bbs administr avec GA Versus RACHIANESTHESIE et ni technique est suprieure une autre en termes d'effet sur ?SpO2 des nouveau-ns 1 , 5 et 10 minutes aprs l'accouchement . Il y avait de diffrence significative dans les mesures de SpO2 15 minutes dans les deux groupes I et II avec IDI prolonge de 15 -30 minutes. Il a t observ que les groupes, j'ai SpO2 infrieure de 80-89 % par rapport au groupe II avec SpO2 de 90-100 % intervalle de 15 minutes aprs C / S. la diffrence tait statistiquement significative . Dans cette tude, tous les nouveau-ns dans les deux groupes prsentaient des signes de la disparition des effets de l'AG et SA par la ralisation maximale de 90-100% SpO2 20 minutes d'intervalle aprs la livraison . L'tude n'a trouv aucune corrlation importante entre les scores d'Apgar mesures de SpO2 et les mesures de SpO2 Preductal taient significativement plus levs que les lectures postductal . Conclusion: Il n'ya pas de diffrence entre l'IDI pour bbs livrs en utilisant GA ou de la moelle et la technique de l'anesthsie n'a eu aucun effet sur ?la SpO2 des nouveau-ns dans les 10 premires minutes de vie . Cependant GA a provoqu une baisse significative de la SpO2 15 minutes Il y avait des preuves d'une rcupration totale des agents anesthsiques par la ralisation maximale de 90-100% SpO2 20 minutes aprs la livraison dans tous les nouveau-ns livrs indpendamment de la technique anesthsique. Nous concluons que la technique de l'anesthsie n'a pas d'effets sur les scores d'Apgar et nonatales SpO2 dans les 10 premires minutes de vie PREDICTORS OF PREOPERATIVE HYPOKALAEMIA IN ADULT GENERAL SURGICAL PATIENTS REQUIRING EMERGENCY INTRA-ABDOMINAL SURGERY Djagbletey R. Institution: Department of Anaesthesia, Korle-Bu Teaching Hospital, Ghana Abstract Background: Potassium is the most abundant intracellular cation in the body and is pivotal in the function of excitable tissues such as nerves, skeletal muscle and cardiac muscle. Hypokalaemia is a common electrolyte abnormality in clinical practice. The incidence and predictors of hypokalaemia has however not been extensively studied in the West African sub- region. The aim of the study was to determine the prevalence and identify the predictive factors of preoperative hypokalaemia in adult surgical patients who require an emergency abdominal surgery. Methods: A cross-sectional study of general surgical patients admitted at the Korle-Bu Teaching Hospital for emergency surgery with a preoperative diagnosis, which requires a laparotomy for management.Following institutional ethics committee's approval, subjects who fulfilled the inclusion criteria were selected consecutively and enrolled into the study. RESULTS: The prevalence of preoperative hypokalaemia was found to be 34.6%. Potassium status was found to be significantly associated with sex, laxative use and serum magnesium status. Multiple regression identified sex and serum magnesium as predictors for hypokalaemia. Male patients are 1.5 times more likely to develop hypokalaemia as compared to female patients. CONCLUSION: Only sex and serum total magnesium were predictive of hypokalaemia. KEY WORDS: Preoperative, potassium, adult surgical patients, emergency, abdominal surgery, predictive factors. INTRODUCTION Le potassium est le cation intracellulaire le plus abondant dans le corps et est pivot dans la fonction des tissus excitables telles que des nerfs, des muscles squelettiques et du muscle cardiaque . L'hypokalimie est une anomalie d'lectrolyte commun dans la pratique clinique . L'incidence et les facteurs prdictifs d'une hypokalimie a cependant pas t tudis dans la sous- rgion ouest-africaine . AIM Pour dterminer la prvalence et d'identifier les facteurs prdictifs d'hypokalimie propratoire chez les patients chirurgicaux adultes qui ont besoin d' une chirurgie abdominale d'urgence . METHODOLOGIE Une tude de Coupe de patients de chirurgie gnrale admise l'hpital Korle -Bu Teaching pour la chirurgie d'urgence avec un diagnostic propratoire qui ncessite une laparotomie pour la gestion. Suite l'approbation institutionnelle comit d'thique, les sujets qui rpondaient aux critres d'inclusion ont t slectionns conscutivement et inscrits dans l'tude . RSULTATS ET ANALYSE La prvalence de l' hypokalimie propratoire s'est rvle tre de 34,6% . Statut de potassium a t trouv associ de faon significative avec le sexe , l'utilisation de laxatifs et le statut de magnsium srique . Rgression multiple a identifi le sexe et le magnsium srique comme facteurs prdictifs de l'hypokalimie . Les patients masculins sont 1,5 fois plus susceptibles de dvelopper une hypokalimie par rapport aux patients de sexe fminin. CONCLUSION Seulement le sexe et le magnsium srique total taient des facteurs prdictifs d'une hypokalimie . Mots cls: les patients chirurgicaux propratoire, potassium , adultes , urgences , chirurgie abdominale ,facteurs prdictifs . COMPARISM OF TWO DIFFERENT ROUTES OF SUXAMETHONIUM ADMINISTRATION AMONGST PAEDIATRIC CASE Background: The failure to secure an intravenous access duringinhalationalinductionofanaesthesiaforpaediatricpatient may be complicated with laryngospasm or bronchospasm. However, in order to avoid these scenarios, a rapid, effective and safe route of administering suxamethonium should be investigated. This study aimed to compare the most effective routeofadministeringsuxamethonium. Methods: Institutional and individual patients ethical approval would be requested. Ten patients would be randomized into two groups, each of 5 five patients. The use of halothane induction at MAC of 0 3% would be done and 109 patients with abdominal respiration will either have intravenous or intralingual (using hypodermal needle) 2mg/kg actual weight basedsuxamethoniumdosesaccordingtoeachgroup. END-POINTS: The time to end fasciculations, intubating conditions, vital signs: Heartrate, SPO2%, NIBPandcomplications willbeobserved. Comparism de deux voies d'administration de suxamthonium diffrents entre cas pdiatrique fond:L'chec obtenir un accs intraveineux pendant l'induction de l'anesthsie par inhalation pour le patient pdiatrique peut tre compliqu avec un laryngospasme ou bronchospasme. Toutefois , afin d'viter ces scnarios , devrait tre tudie une voie rapide , efficace et scuritaire de l'administration de suxamthonium . Objectif: L'tude est de comparer l'itinraire le plus efficace d'administrer le suxamthonium . Matriels et mthodes: Patients individuels et institutionnels approbation thique serait demand. Dix patients seront randomiss en deux groupes , chacun des cinq 5 patients . L'utilisation de l'halothane induction au MAC de 0 - 3 % serait fait et les patients atteints de la respiration abdominale devra soit par voie intraveineuse ou intralinguale (avec aiguille hypodermique) 2mg/kg poids rels sur la base des doses de suxamethonium selon chaque groupe. Le temps de mettre fin fasciculations, les conditions d'intubation , les signes vitaux : frquence cardiaque , SpO2 % , PNI et les complications sera observe. WHAT ARE THE CHARACTERISTICS OF INTENSIVE CARE UNITS IN FAILURE-TO-RESCUE OUTLIER HOSPITALS? Denise Asafo-Adjei, Elliot Wakeam, Zara Cooper, Stanley Ashley, Joel S. Weissman Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, USA  HYPERLINK "mailto:Daa891@mail.harvard.edu" \h CORRESPONDENCE:Daa891@mail.harvard.edu Abstract Background: Failure-to-rescue (FTR), the mortality rate among surgical patients who develop complications, is an emerging quality metric. Since the Intensive Care Unit (ICU) is often the final common pathway for FTR, we assessed characteristics of ICUs associated with high and low outlier hospitals. Methods: Using 2009-2011 FTR rates from Medicare's Hospital Compare database, we identified 139 outlier hospitals (significantly better/worse than the national average). We surveyed ICU directors and nurse managers regarding characteristics such as physical ICU structures, patient composition, staffing, care protocols, rapid response teams (RRT), and micro-system resources. Logistic regression, controlling for Medicaid burden and trauma center status, was used to create adjusted odds ratios (AOR) for predictors of low outlier status. Results: 67 hospitals completed the survey (48% response rate). Responders were more likely to be teaching hospitals (40.9% vs. 25.0%%, p=0.05) but were similar to non-responders in terms of hospital size and ownership. Having an intensivist as a member of the RRT was the strongest predictor of low outlier status (AOR 23.38 CI2.06 265.95, p=0.01). On-site intensivists (AOR 6.26, p=0.06), multidisciplinary rounds (AOR 4.33, p=0.09), and a pulmonologist (AOR 4.96, p=0.03) also predicted low outliers. High Medicaid and Level 1 trauma status predicted high outliers (AOR 0.16, p=0.0002, and AOR 0.35, p=0.09, respectively). CONCLUSIONS: Intensivist presence on the RRT may result in the right knowledge at the bedside during periods of acute deterioration, resulting in better patient outcomes. Large teaching and trauma centers that care for Medicaid patients fare poorly on the FTR metric. QUELLES SONT LES CARACTERISTIQUES DE units de soins intensifs l'chec -- Resuce aberrantes HPITAUX ? Objectif: chec sauvetage ( FTR ) , le taux de mortalit chez les patients chirurgicaux qui dveloppent des complications , est un indicateur de la qualit mergente . Depuis l' unit de soins intensifs (USI ) est souvent la voie finale commune pour FTR , nous avons valu les caractristiques des units de soins intensifs des hpitaux associs hautes et basses aberrantes . Mthodes : Utilisation de 2009-2011 taux FTR de l'assurance- maladie de l'Hpital Comparer base de donnes , nous avons identifi 139 hpitaux aberrantes ( nettement mieux / pire que la moyenne nationale ) . Nous avons interrog les directeurs de soins intensifs et les infirmires gestionnaires concernant les caractristiques telles que les structures physiques de soins intensifs , de la composition du patient , le personnel, les protocoles de soins , les quipes d'intervention rapide ( EIR ) , et des ressources micro- systme . Rgression logistique , contrle de Medicaid charge et l'tat de centre de traumatologie , a t utilis pour crer les odds ratios ajusts ( AOR) pour les prdicteurs de la situation de faible valeur aberrante . Rsultats: 67 hpitaux ont rempli le questionnaire (taux de rponse de 48 % ) . Les intervenants taient plus susceptibles d' tre les hpitaux d'enseignement ( 40,9 % vs 25,0 % % , p = 0,05 ), mais taient similaires aux non-rpondants en termes de taille et de la proprit hpital . Avoir un ranimateur en tant que membre de la Commission de contrle a t le plus fort prdicteur de faible statut des valeurs aberrantes ( AOR 23.38 CI2.06 - 265.95 , p = 0,01 ) . Ranimateurs sur place ( AOR 6,26 , p = 0,06 ) , tournes multidisciplinaires ( AOR 4,33 , p = 0,09 ) , et un pneumologue ( AOR 4,96 , p = 0,03 ) ont galement prdit faibles valeurs aberrantes . Haute Medicaid et Level tat ?1 de traumatisme prdit aberrantes leves ( AOR 0,16 , p = 0,0002 , et AOR 0,35 , p = 0,09, respectivement) . Conclusions: prsence intensiviste sur le RRT peuvent entraner les connaissances au chevet pendant les priodes de dtrioration aigu, rsultant dans de meilleures rsultats pour les patients. Enseignement et de traumatologie grands centres qui s'occupent des patients de Medicaid s'en sortent mal sur la mtrique FTR. CO-OXIMETERY IN ELECTIVE SURGICAL PROCEDURES IN LAUTECH TEACHING HOSPITAL, Osogbo Abstract Background: Co-Oximetry was previously a laboratory investigation in most patient care around the world. The advent of point of care testing has made it available at patient bedside. This will afford clinicians ability to march clinical condition with result of investigation and intervene promptly. The likelihood of this point of care testing to substitute pulse oximetry analysis needs to be confirmed. Methods: This is a prospective study on patients undergoing elective surgeries at the LAUTECH Teaching Hospital during the months of November and December,2013. The use of the Masimo RAD-7 Co-Oximetry to monitor patients Pulse rate, Perfusion index, Perfusion Variability Index, Hemoglobin level, Methhemoglobin level, and Oxygen content(based on Oxygen flux equation) at 10 minutes intervals. The estimated blood loss by both the attending surgeon and anaesthetist would be compared with the Masimo RAD-7 Co-Oximetry finding. 110 END-POINTS: All data will be subjected to statistical analysis using SPSS version 21 and a p value of < 0.05 will be considered statistically significant. CO - OXIMETERY DANS LES INTERVENTIONS CHIRURGICALES ELECTIVES DANS CHU LAUTECH, OSOGBO. fond Co - oxymtrie tait auparavant une enqute de laboratoire dans la plupart des soins aux patients dans le monde entier . L'avnement du point de tests de soins a rendu disponible au chevet du patient . Ce sera la capacit de payer les cliniciens marcher tat ?clinique avec un rsultat de l'enqute et intervenir rapidement . La probabilit de ce point de tests de soins remplacer l'analyse d'oxymtrie de pouls doit tre confirme. Matriels et mthodes Il s'agit d'une tude prospective sur les patients subissant des chirurgies lectives l'hpital LAUTECH enseignement pendant les mois de Novembre et Dcembre 2013 . L'utilisation de la Masimo RAD- 7 co- oxymtrie de surveiller les patients du pouls , l'indice de perfusion , la perfusion Index variabilit , niveau d'hmoglobine , niveau Methhemoglobin , et la teneur en oxygne ( bas sur l'quation de flux d'oxygne ) intervalles de 10 minutes . La perte de sang estime la fois par le chirurgien traitant et l'anesthsiste serait compare la Masimo RAD- 7 co- oxymtrie conclusion . Toutes les donnes seront soumises une analyse statistique en utilisant la version SPSS 21 et une valeur de p <0,05 sera considre comme statistiquement significative. DOES MIDAZOLAM PRODUCE RETROGRADE AMNESIA IN SURGICAL PATIENTS? Yakubu S Y, Eguma S A, Mohammed R I Department of Anaesthesia, ABU Teaching Hospital, Shika- Zaria, Nigeria CORRESPONDENCE:  HYPERLINK "mailto:saiduyakubu@gmail.com" \h saiduyak HYPERLINK "mailto:ubu@gmail.com" \h ubu@gmail.com Abstract Background: Although diazepam is widely used in the anaesthetic practice in West Africa for premedication, induction and maintenance of anaesthesia, midazolam is preferable to diazepam in many clinical situations because of its rapid onset, non-painful injection, and lack of venous irritation and production of anterograde amnesia. The objective was to determine whether immediate retrograde amnesia can be produced with intravenous midazolam and to elicit the extent of amnesia seen in adult patients given midazolam at induction. Methods: Eighty consenting ASA I and II patients between 18 and 60 years scheduled for non-major elective surgical procedures under General anaesthesia were randomly allocated to one of four study groups: m2 (midazolam 2 mg), m5 (midazolam 5mg), m7 (midazolam 7mg) or m0 (normal saline). Visual recognition and recall was tested using 12 picture cards, each with an easily recognizable image. Results: Recognition and recall rates were similar between the groups up till the time of study drug administration. There was a dose-dependent deterioration in visual recall (P<0.001), orientation in time, event recollection (P<0.001), and mean sedation scores (P<0.001) following iv midazolam when compared with control. There was statistically significant anterograde amnesia for pictures seen after administration of midazolam (P=0.000). There was no evidence of retrograde amnesia (P>0.3). Conclusions: Intravenous Midazolam does not cause retrograde amnesia. It causes anterograde amnesia in a dose- responsive manner. NE PRODUIT MIDAZOLAM RTROGRADE AMNESIA chez les patients chirurgicaux? CONTEXTE: Bien que le diazpam est largement utilis dans la pratique de l'anesthsie en Afrique de l'Ouest pour la prmdication , induction et l'entretien de l'anesthsie , le midazolam est prfrable au diazpam dans de nombreuses situations cliniques en raison de son dbut d'action rapide , l'injection non douloureuse , l'absence d'irritation veineuse et la production de amnsie antrograde . OBJECTIFS: Pour dterminer si une amnsie rtrograde immdiate peut tre produite avec le midazolam par voie intraveineuse et de solliciter la mesure de l'amnsie observe chez les patients adultes donns midazolam induction. MTHODE: Quatre-vingt consentir ASA I et II patients entre 18 et 60 ans prvues pour non - majeurs interventions chirurgicales sous anesthsie gnrale ont t affects au hasard l'un des quatre groupes d'tude : m2 ( 2 mg de midazolam ) , m5 ( midazolam 5mg) , M7 ( midazolam 7 mg ) ou M0 (solution saline normale ) . La reconnaissance visuelle et le rappel a t test en utilisant 12 cartes illustres, chacune avec une image facilement reconnaissable. RSULTATS: comptabilisation et taux de rappel taient similaires entre les groupes jusqu' l'poque de l'tude l'administrationdumdicament. Il y avait une dtriorationdela dose-dpendante de rappel visuel (P <0,001 ), l'orientation dans le temps, unvnementsouvenir( P<0,001 ) , et lamoyennedes scoresdesdation(P< 0,001 ) suivant ivmidazolamparrapport un contrle . Il y avait une amnsie antrograde statistiquement significative pour les images observes aprs administration de midazolam (P = 0,000) . Il n'y avait aucune preuve de l'amnsie rtrograde(P> 0,3 ) . CONCLUSIONS: Le midazolam par voie intraveineuse ne provoque une amnsie rtrograde. Il provoque une amnsie antrogradedemaniredose- rponse REVIEW OF OROPHARYNGEAL TUMOURS AMONG NIGERIANS: 5 YEARS EXPERIENCE OF THE UNIVERSITY OF ILORIN TEACHING HOSPITAL Omokanye H K, Alabi B S, Afolabi O A, Dunmade A D, Iyanda N O Dept. of Otorhinolaryngology, UITH, Ilorin, Nigeria. CORRESPONDENCE:  HYPERLINK "mailto:alabibs@yahoo.com" \h alabibs@yahoo.com Abstract Background: About 10% to 12% of all head and neck malignancies are oropharyngeal tumours,more than 90% of which are histologically squamous cell carcinomas (SCC). Male population has a higher prevalence of oropharyngeal tumours. The aim of this study is to determineincidence of oropharyngeal tumours and its relationship to socio- demographic factors. Methods: This is a retrospective study. Medical records of patients diagnosed and managed for oropharyngeal tumours at the department of otorhinolaryngology, Ilorin, Nigeria from January, 2008 to June2013 were retrieved and reviewed for clinical data. Results: There were a total of 27 cases of oropharyngeal tumours, 17 (63.6%) were females and 10 (36.4%) males with male to female ratio 1:1.7. 20 (72.7%) were non-smokers while 7 (27.3%) were smokers. 10 (36.4%) had history of alcohol 111 intake while 17 (63.4%) did not takealcohol. Of the total number of patients, 15 (54.6%) were within 40-60 years, 7 (27.3%) were below 40 years (38 years) and 5 (18.2%) above 60 years. Base of the tongue tumoursconstituted 55.6% (15) of the total, closely followed by lateral wall tumours (tonsils) 7 (27.3%), then soft palatal tumours 5 (18.2%). None in the posterior pharyngeal wall. 10 (36.4%) hadsurgery and referred for chemoradiation while 17 (63.4%) either declined surgery or defaultedfrom clinic follow-up. However, 2 (7.4%) cases had associated HIV infection. Conclusion: This study showed relative high incidence in females, non-smokers, young adultsand middle-aged which reflected the pattern of HPV-induced oroparyngeal tumours, although history of orogenital sex was not probed. KEY WORDS: Oropharyngeal tumours, non-smokers,middle aged,base of the tongue EXAMEN DES TUMEURS OROPHARYNGEES CHEZ LES NIGERIANS: 5 ANNEES D'EXPERIENCE DE L'UNIVERSITE D'ILORINHOPITALD'ENSEIGNEMENT rsum Introduction: Environ 10 % 12 % de toutes les tumeurs malignes de la tte et du cou sont des tumeurs de l'oropharynx,plus de 90 % sont des carcinomes des cellules squameuses (SCC) histologiquement . population masculine a une prvalence plus leve de tumeurs oropharynges. Le but de cette tude est de dterminer l'incidence des tumeurs de l'oropharynx et de sa relation des facteurs socio- dmographiques . Mthodes: Il s'agit d'une tude rtrospective. Les dossiers m d i c a u x d e p a t i e n t s d i a g n o s t i q u s e t p o u r tumeurs de l'oropharynx au dpartement de ORL, Ilorin, Nigeria partir de Janvier, 2008 Juin 2013, ont t rcuprs et examins pour des donnes cliniques. Rsultats: Il y avait un total de 27 cas de tumeurs de l'oropharynx , 17 ( 63,6 % ) taient des femmes et 10 ( 36,4 % ) des mles avec mle femelle rapport 1:1,7 . 20 (72,7 % ) taient des non- fumeurs , tandis que 7 ( 27,3% ) taient des fumeurs . 10 (36,4 %) ont eu l'histoire de la consommation d'alcool , tandis que 17 ( 63,4 % ) n'a pas pris alcool . Sur le nombre total de patients, 15 (54,6 %) taient dans les 40-60 ans , 7 ( 27,3% ) taient dessous de 40 ans (38 ans) et 5 ( 18,2% ) plus de 60 ans . Base de des tumeurs de la langue constitu 55,6 % ( 15 ) du total , suivie de prs par tumeurs de la paroi latrale (de amygdales) 7 (27,3%), alors palatine doux tumeurs 5 ( 18,2%). Aucundanslaparoipostrieuredupharynx. 10 (36,4 %) avaitchirurgie et renvoy la radiochimiothrapie tandis que 17 ( 63,4 %) soit refus la chirurgie ou par dfaut de suivi clinique. Cependant, deux (7,4%) cas ont associ l'infectionau VIH. Conclusion: Cette tude a montr relativement lev incidence chez les femmes , non-fumeurs , les jeunes adultes et d'ge moyen qui reflte le modle de tumeurs induites par le VPH oroparyngeal, bienquehistoiredesexeoron'apastsond. Mots cls: tumeurs oropharynges, non-fumeurs, d'ge moyen , base de la langue PATTERN OF SINONASAL CANCERS IN ILORIN, NIGERIA. Afolabi O A, Alabi BS, Dunmade A D, Ayodele S O Dept. of Otorhinolaryngology, UITH, Ilorin, Nigeria. CORRESPONDENCE:  HYPERLINK "mailto:alabibs@yahoo.com" \h alabibs@yahoo.com Abstract Background: Sinonasal cancer is an uncommon tumour in Nigeria but the burden of thedisease in terms of morbidity and mortality is on the increase.The aim of this study is to evaluate the pattern of presentation and outcome of sinonasalcancer in University of Ilorin Teaching Hospital, Ilorin, Kwara state. Methods: This was a retrospective review of all the patients with sinonasal cancer seen in ENT Department of the hospital between January 2008 and October2013. The patients' bio data, clinical presentation, stage of the disease at presentation, identifiablerisk factors, histopathological findings and outcome were presented. Results: A total of 22 patients were diagnosed with sinonasal cancer out of 71 patients (31%) with head/neck cancers during the period of study. There were 12 males (54.5%) and 10females (45.5%) with a mean age of 50years. Epistaxis, nasal blockage and discharge were seenin all patients though 41% of wood dust (59.1%) and petrochemical products (24%).Most patients presented first at advanced stages of the disease (82%). Histologically well-differentiated squamous cell carcinoma was the commonest (55%) followed by non- intestinalwell-differentiated adenocarcinoma and plasmacytoma (10%). Chemo radiation was themainstay of management in (38%) though (13.6%) had total maxillectomy with post-surgical chemo radiation and 48.4% defaulted due to cost of management. Conclusion: Health education on early presentation and efforts at early detection of the disease are needed to achieve cure. Exposure to the identifiable risk factors should be reduced by protective measures. Easy access to radiotherapy at affordable price will surely improve outcomeof this disease. KEY WORDS: Pattern, sinonasal tumours. advanced stage, chemoradiation, MOTIF DE CANCERS NASO-SINUSIENS A ILORIN, NIGERIA CONTEXTE - sinonasal cancer est une tumeur rare au Nigeria, mais le fardeau de la maladie en termes de morbidit et de mortalit est en augmentation AIM - L'objectif de cette tude est d'valuer le modle de prsentation et les rsultats des nez et des sinus cancer l'Universit de CHU Ilorin, Ilorin, tat ?de Kwara. MATRIEL ET MTHODES - Ce fut une revue rtrospective de tous les patients atteints de cancer naso-sinusienne vu dans ENT ministre de l'hpital entre Janvier 2008 et Octobre 2013. Le donnes biographiques des patients la prsentation clinique, le stade de la maladie lors de la prsentation, identifiable facteurs de r i sque , les rsultats histopathologiques et les rsultats ont t prsents . RESULTATS - Un total de 22 patients ont t diagnostiqus avec le cancer naso-sinusienne sur 71 patients (31% ) des cancers tte / cou au cours de la priode d'tude . Il y avait 12males (54,5 %) et 10les femmes ( 45,5 % ) avec un ge moyen de 50 annes . pistaxis, obstruction nasale et la dcharge ont t observs chez tous les patients quoique 41% des patients d'abord prsent l'ophtalmologiste en raison de l'exophtalmie. Facteurs de risque identifiables taient l'exposition la poussire de bois (59,1 %) et les produits ptrochimiques (24 % ) . La plupart des patients ont prsent d'abord des stades avancs de la maladie (82 %). histologiquement bien carcinome pidermode diffrencie est la plus frquente (55%) suivie par intestinal non adnocarcinome bien diffrenci et Plasmocytome (10 %). Rayonnement de chimio tait la pilier de la gestion de (38 %), mme si (13,6% ) avait totale Maxillectomie post- chirurgicale rayonnement de la chimiothrapie et de 48,4% en dfaut en raison des cots de gestion . CONCLUSION - ducation la sant sur la prsentation et les efforts tt la dtection prcoce de lasont ncessaires pour obtenir la gurison des maladies. L'exposition des facteurs de risque identifiables doit tre rduite par. Les mesures de 112 protection. Facile d'accs la radiothrapie un prix abordable va srement amliorer les rsultats de cette maladie. Mots cls: modle, tumeurs naso- s inusales. Stade avanc, radiochimiothrapie AUDIOLOGICAL PROFILE OF DIABETIC PATIENTS ATTENDING ENDOCRINOLOGY CLINIC IN A NIGERIAN TERTIARY HOSPITAL 1 Adebola S O, 2Olamoyegun M A, 1Babarinde J A, 1Oyelakin O A, 3Sogebi O A Institution:1Department of Otorhinolaryngology, LAUTECH Teaching Hospital, Ogbomoso, Nigeria; 2Department of Internal Medicine, LAUTECH Teaching Hospital, Ogbomoso, Nigeria; 3Otorhinolaryngology Unit, Department of Surgery, Olabisi Onabanjo University, Sagamu, Nigeria  HYPERLINK "mailto:tosinadebolang@yahoo.com" \h CORRESPONDENCE:tosinadebolang@yahoo.com Abstract Background: To assess clinical features and hearing acuity in type 2 diabetic (T2DM) patients using otoscopy and pure tone audiometry. Also, to explore if T2DM has effects on auditory acuity by comparing audiometric parameters in T2DM patients with a matched control group. Methods: Hospital-based prospective study conducted on patients attending out-patient clinics in Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, Nigeria. Test subjects were T2DM patients attending Endocrinology clinic, while control group were non- diabetic patients matched for age and sex. Data generated from the clinical information, otoscopic and PTA findings of all the 187 consenting patients. Results: Age ranged between 31 and 90 years; mean 58.914.9 (Test) and 58.814.7 (Control). No significant difference in gender distribution (P=0.916) and socio-economic class (P=0.438) between the two groups of patients. The T2DM patients had been diagnosed for an average of 7.66.4 years, with 65.8% among them having sensorineural hearing loss (SNHL), and 39.0% having moderately-severe hearing loss. Comparative analysis revealed significantly more of the T2DM patients were obese (P=<0.001), had sensori-neural hearing loss (P=<0.001) and had moderately-severe hearing loss (P=0.233) compared with the controls. Conclusion: T2DM had appreciable effects on hearing acuity. T2DM significantly affected the type and the degree of hearing loss. There is a need for screening of hearing acuity of T2DM patients, in order to detect the changes early, offer prompt, adequate management and remedial measures as appropriate. KEYWORDS: Diabetes mellitus, Otoscopy, Pure Tone Audiometry, Nigeria PROFIL AUDIOLOGIQUE DES PATIENTS DIABETIQUES ASSISTANT ENDOCRINOLOGIE DANS UN HPITAL TERTIAIRE NIGERIAN. rsum Objectifs: valuer ls caractristiques cliniques et de l'acuit auditive dans ( DT2 ) chez les patients diabtiques de type 2 l'aide otoscopie et pur audiomtrie tonale . Aussi explorer si DT2 a des effets sur l'acuit auditive en comparant les paramtres audiomtriques chez les patients diabtiques de type 2 avec un groupe tmoin . Conception de l'tude et Cadre: tude prospective en milieu hospitalier ralise chez des patients frquentant les cliniques de consultation externe dans Ladoke Akintola University of Technology (LAUTECH ) CHU ?, Ogbomoso , Nigeria . Les sujets tests ont t patients atteints de DT2 participant endocrinologie clinique tandis que le groupe de contrle taient des patients non diabtiques apparis pour l'ge et le sexe. Mthodes: Les donnes gnres par les donnes cliniques, les rsultats otoscopiques et PTA de tous les 187 patients consentants. Rsultats: l'ge variait entre 31 et 90 ans, moyenne de 58,9 14,9 (Test) et 58,8 14,7 ( Control) . Aucune diffrence significative dans la rpartition par sexe ( P = 0,916 ) et la classe socio- conomique ( P = 0,438 ) entre les deux groupes de patients. Les patients atteints de DT2 avaient t diagnostiqus pour une moyenne de 7,6 6,4 ans, 65,8 % d'entre eux ayant une perte auditive neurosensorielle ( surdit de perception ) , et 39,0% ayant modrment svre perte auditive . L'analyse comparative a rvl significativement plus de patients diabtiques de type 2 taient obses ( P = <0,001 ) , eu neurosensorielle perte d'audition ( P = <0,001 ) et avaient modrment svre perte auditive ( P = 0,233 ) par rapport aux tmoins . Conclusion: DT2 eu des effets sensibles sur l'acuit auditive . DT2 affecte de manire significative le type et le degr de perte auditive. Il est ncessaire pour le dpistage de l'acuit des patients atteints de DT2 entendu , afin de dtecter les changements au dbut , offre rapide , une gestion adquate et desmesurescorrectiveslecaschant. Mots-cls: diabte sucr , Otoscopie , Pure audiomtrie Tone , Nigeria ENDOSCOPIC MEDIAL MAXILLECTOMY FOR NASAL LESIONS: A PERSONAL EXPERIENCE AND VIDEO DEMONSTRATION OF THE TECHNIQUE. Anthony O. O, Ogadako R.M, Tedadjo R Lagos State University Hospital, Lagos, Nigeria Abstract Background: Medial maxillectomy have traditionally been done using an open technique using either mid facial degloving, sub-labial incisions or an open facial approach such as a Weber-Ferguson incision with its attendant problem with cosmesis and scarring.With improved instrumentation and optics and video camera systems it is now possible to do this procedure entirely endoscopically. The author presents his figures and shows a video recording of the technique. Methods: The records of all patients that had a medial maxillectomy by the author over a 10 year period were collated. 11 patients were identified. 3 patients had fungal sinusitis, 7 patients had inverting papilloma One patient turned out has having inflammatory disease. Results: No recurrence observed during a review spanning 2- 9 years utilizing both endoscopic and routing imaging. 2 patients had a post op nose bleed with none requiring surgical intervention.No epiphora was reported in the group, however 2 patients developed atrophic rhinitis EXTENDED USE OF THE ENDOSCOPE IN EAR SURGERY. ENDOSCOPIC REMOVAL OF A PETROUS APEX LESION - VIDEO DEMONSTRATION OF TECHNIQUE Anthony Owa, Ogadako R.M. Lagos State University Hospital, Lagos, Nigeria Abstract INTRODUCTION: We present the case of 64-year old Caucasian who was referred to our unit with a 7-year history of left facial palsy previously misdiagnosed as Bell's palsy. A subsequent MRI revealed a lesion of the petrous apex, 113 expanding the geniculate ganglion and eroding the Tegmen. The MRI was reported as a cholesteatoma though a clinical suspicion of facial neuroma was entertained. The patient opted against surgery initially until he started developing seizures. The decision was then decided based on the scans to remove the lesion endoscopically as it was likely to be less invasive. CONCLUSION: In selected cases an endoscopic approach either wholly or in combination with a microscope is a viable means of dealing with these lesions although skilled training is advisable before commencing this procedure. UNE UTILISATION PROLONGEE DE L'ENDOSCOPE EN CHIRURGIE DE L'OREILLE . EXTRACTION ENDOSCOPIQUE D'UNE LESON SOMMET DU ROCHER . VIDEO DE DEMONSTRATION DE LA TECHNIQUE Nous prsentons le cas de 64 ans de race blanche qui a t renvoy notre unit avec une histoire de 7 ans de paralysie faciale gauche prcdemment diagnostique tort comme la paralysie de Bell . Une IRM subsquente a rvl une lsion de la pointe du rocher, l'largissement du ganglion gnicul et roder la Tegmen. L' IRM a t signal comme un cholestatome si une suspicion clinique de neurinome du visage a t diverti . Le patient a opt contre la chirurgie initialement jusqu' ce qu'il a commenc dvelopper des convulsions. La dcision a alors t dcid sur la base des analyses pour liminer la lsion endoscopique car il tait susceptible d'tre moins invasive. CONCLUSION Dans certains cas une approche endoscopique en tout ou en combinaison avec un microscope est un moyen viable de traiter cette lsion bien que la formation qualifie est conseill avant de commencer cetteprocdure PURE TONE AUDIOMETRIC FINDINGS IN PATIENTS ON SECOND LINE DRUG TREATMENT FOR MULTI-DRUG RESISTANT STRAIN TUBERCULOSIS Ibekwe Matilda Uju*, Chibuike Nwosu Department of ENT Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State. Nigeria. *Corresponding author - Email:  HYPERLINK "mailto:ibekwe_uju@yahoo.com" \h ibekwe_uju@yahoo.com, +234 8023093137 issue since there is a growing increase in MDR-TB in our environment. Keywords: Pure tone audiometry, SNHL, MDR-TB, second line antitubercular drugs. PURE TONE RESULTATS AUDIOMETRIQUES CHEZ LES PATIENTS SOUS TRAITEMENT DE DEUXIEME LIGNE POUR LES MEDICAMENTS DE PLUSIEURS MEDICAMENTS SOUCHE RESISTANTE DE LA TUBERCULOSE Contexte La ncessit d'une deuxime ligne de mdicaments antituberculeux a t la hausse en raison de l'mergence de plusieurs mdicaments souche rsistante de la tuberculose ( TB-MR) dans notre environnement . Le but de cette tude est d'valuer l'effet de la deuxime ligne de mdicaments antituberculeux en entendant chez les patients atteints de MDR -TB. Mthode: Il s'agit d'une tude prospective de tous les patients admis au Centre MDR -TB de l'universit de Port Harcourt hpital d'enseignement ( UPTH ) entre Janvier et mai 2013. Tous les patients avaient audiomtrie tonale fait trois ( 3) mois avant et aprs le dbut de la deuxime ligne de mdicaments antituberculeux . La deuxime ligne de traitement utilis comprend la kanamycine, la lvofloxacine, la cyclosrine , pyrazinamide, et lapyridoxine. Rsultats: L'tude avaient un total de 28 patients. Il y avait 14 hommeset 14 femmes. Latranched'gesesituaitentre 18 et 68 ans. 14 patientsonteudesdegrsdiffrentsdehautefrquence perte auditive neurosensorielle (surdit de perception) aprs un traitement de 3 mois. Il y avait 13 bilatrale et une dficience auditive unilatrale. 2 patients avaient une surdit de perception profonde. Cependant, un bon nombre avaient une atteintedesfrquencesdelaparole. Conclusion: Deuxime ligne de mdicaments antituberculeux semble avoir un effet norme sur l'audition. Cela pose un problme de sant publique car il ya une augmentation croissante de la TB-MR dans notre environnement. Mots-cls: Pure audiomtrie tonale, une surdit deperception, la TB-MR, deuximelignedemdicamentsantituberculeux. RAMSAY HUNT SYNDROME: CASE SERIES IN IBADAN AND REVIEW OF LITERATURE Ijitola J. O, Adeyemo A A Abstract Background: The need for second line antitubercular medication has been on the increase due to the emergence of multi-drug resistant strain tuberculosis (MDR-TB) in our environment. The aim of this study is to assess the effect of second line antitubercular medication on hearing in patients with MDR-TB. Method: This is a prospective study of all the patients admitted at the MDR-TB Center of the university of Port Harcourt teaching hospital (UPTH) between January and May 2013. All patients had pure tone Audiometry done before and three (3) months after commencement of second line antitubercular medications. The second line regimen used includes kanamicin, levofloxacin, cycloserine, pyrazinamide, and pyridoxine. Results: The study had a total of 28 patients. There were 14 males and 14 females. The age range was between 18 and 68 years. 14 patients had different degrees of high frequency sensorineural hearing loss (SNHL) after 3 months therapy. There were 13 bilateral and 1 unilateral hearing impairments. 2 patients had profound SNHL. However, a good number had involvement of the speech frequencies. Conclusion: Second-line antitubercular medication appears to have tremendous effect on hearing. This raises a public health  Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria CORRESPONDENCE: Department of Otorhinolaryngology, University College Hospital, Queen Elizabeth Road, PMB 5116, Ibadan, Oyo State, Nigeria. Email:  HYPERLINK "mailto:adebolajo@yahoo.com" \h adebolajo@yahoo.com Abstract Background: Ramsay Hunt Syndrome (RHS) is peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth caused by varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve. Immunocompromised and elderly patients may have a more prolonged and severe course. It is a relatively rare clinical event and it has been said that some ENT physicians may not come across a case of RHS in their entire career. This paper aims to present a case series of patients seen in Ibadan with a review of current literature. Methods: A retrospective 5-year-review of the cases seen in the Department of Otorhinolaryngology, University College Hospital, Ibadan. 114 Results: Six patients between the third and eighth decades of life presented with the classical clinical features of RHS with a M:F of 1:1 and prevalence of 86 cases per 100, 000. They presented within 5 days to 3 weeks of onset of illness. Both ears were equally affected in these patients. They were treated with prednisolone, acyclovir, and anti-inflammatory drug. Only one of the patients had ophthalmology assessment and was placed on chloramphenicol eye ointment. None of these patients did the requested investigations and also did not come for follow up. In the current literature, RHS is the second most common cause of atraumatic peripheral facial paralysis and it has been described in all age groups, approximately 67 cases per 100, 000 population in the United States of America; more common in the female sex and affected the right ear more. The largest retrospective treatment study as well as the collective published literature showed a statistically significant improvement in patients treated with acyclovir and prednisolone within 3 days of onset. Conclusion: Although it is a relatively rare disease entity, there is an increase in the prevalence of RHS in Ibadan. Unfortunately, the patients' immune status could not be ascertained to correlate it with its association with RHS. KEYWORDS: Ramsay Hunt Syndrome, prednisolone, acyclovir, Ibadan SYNDROME HUNT RAMSAY : SERIE DE CAS A IBADAN ET REVUE DE LA LITTERATURE rsum Contexte: Le Syndrome de Ramsay Hunt (ERS) est priphrique paralysie du nerf facial accompagn d'une ruption vsiculaire rythmateuse sur l'oreille (zona oticus) ou dans la bouche cause par le virus de la varicelle -zona (VZV) dans le ganglion gnicul du nerf facial . Les patients immunodprims et les personnes ges peuvent avoir un cours plus grave et prolonge. Il s'agit d'un vnement clinique relativement rare et il a t dit que certains mdecins ORL peuvent pas venir travers un cas d'ERS dans toute leur carrire. Objectif: Prsenter une srie de patients vus Ibadan avec une revue de la littrature actuelle de cas. Mthode: A 5 ans, tude rtrospective des cas observs dans le dpartement de rhino-laryngologie, l'University College Hospital, Ibadan. Rsultat : Six patients entre les troisime et huitime annes de la vie prsentent les caractristiques cliniques classiques de RHS avec un M : F de 1:1 et la prvalence de 86 cas pour 100 000. Ils ont prsent un dlai de 5 jours 3 semaines suivant l'apparition de la maladie. Les deux oreilles sont galement affects ces patients. Ils ont t traits avec de la prednisolone, l'acyclovir, et mdicament anti-inflammatoire. Un seul des patients avaient valuation de l'ophtalmologie et a t plac sur le chloramphnicol pommade ophtalmique. Aucun de ces patients n'a l' enqute a demand et n'a pas non plus venu pour le suivi. Dans la littrature actuelle, l'ERS est la deuxime cause la plus frquente de atraumatique paralysie faciale priphrique et il a t dcrit dans tous les groupes d'ge, environ 67 cas pour 100 000 habitants aux tats-Unis d'Amrique ; plus communes dans le sexe fminin et affectes l'oreille droite plus. La plus grande tude de traitement rtroactif ainsi que la littrature publie collective ont montr une amlioration statistiquement significative chez les patients traits avec l'acyclovir et la prednisolone dans les 3 jours suivant l'apparition. Conclusion: Bien que ce soit une entit de maladie relativement rare, il ya une augmentation de la prvalence de l'ERS Ibadan. Malheureusement, l'tat immunitaire des patients ne pouvait pas tre tabli corrler avec son association avec ERS. Mots-cls: syndrome de Ramsay Hunt, la prednisolone, l'acyclovir , Ibadan TEACHING LARYNGECTOMY IN CAMEROON Tony Mwenyemali, Acha Everistus, Richard Bardin, Wayne Koch Mbingo Baptist Hospital, Cameroon Abstract Background: Laryngeal cancer is common in Cameroon despite a low level of cigarette smoking. Scarcity of diagnostic, surgical and radiation services and late presentation of patients adversely affect management. Living conditions, language diversity and a wide-spread populace present challenges in post-operative rehabilitation. Methods: This study is a retrospective review of laryngectomy cases performed at Mbingo Baptist Hospital (MBH), a teaching hospital in Northwest Cameroon. The surgical team included general surgery residents in the Pan African Academy of Christian Surgeons (PAACS) program. This study was approved by the MBH IRB. Results: 12 procedures were performed between 2008 and 2013 involving 11males and 1 female. Ages ranged from 25 to 78 years (mean 51years). Four patients required emergent tracheotomy before tumor diagnosis. All patients were evaluated with flexible fiberoptic nasolaryngoscopy, direct laryngoscopy and biopsy and in some cases CT scan. Nine (75%) patients had total laryngectomy (for Stage III-IV disease) with/without selective neck dissection. 3(25%) had vertical hemilaryngectomy. One patient has had documented tumor recurrence and one has died of other causes while free of cancer. In the post-operative period 2 (16%) patients developed pharyngo- cutaneous fistulas. Post- op radiotherapy was unavailable. All patients returned to their homes without problems with diet, stoma care or hygiene. Electrolarynx devices were provided for voice restoration. CONCLUSION: Laryngectomy is a valuable component of surgical training in Africa. There is a need for speech and swallowing therapists for pre-operative counseling and post- operative rehabilitation as well as for radiotherapy. ENSEIGNEMENT LARYNGECTOMIE AU CAMEROUN Contexte: cancer du larynx est commun au Cameroun, malgr un niveau de tabagisme bas. La raret des services de chirurgie et de radiation de diagnostic et la prsentation tardive des patients nuisent gestion. Les conditions de vie, la diversit linguistique et un rpandues populace dfis actuels en matire de radaptation post-opratoire. Mthodes: Cette tude est une tude rtrospective des cas de laryngectomie effectues l'Hpital Mbingo Baptiste (MBH) , un hpital d'enseignement au nord-ouest du Cameroun. L'quipe chirurgicale inclus rsidents en chirurgie gnrale l'Acadmie panafricaine des programmes (PAACS) chrtiens chirurgiens. Cettetude a t approuve par le MBH CISR. Rsultats: 12 procdures ont t ralises entre 2008 et 2013 impliquant 11males et 1 femelle. ge variait de 25 78 annes (51Y moyenne). Quatre patients ont ncessit mergente trachotomie avant le diagnostic de la tumeur. Tous les 115 patients ont t valus avec nasolaryngoscopy fibre optique flexible, laryngoscopie directe et la biopsie et dans certains cas, la tomodensitomtrie. Neuf (75 %) patients avaient une laryngectomie totale (pour une tumeur de stade III - IV) avec / sans curage slectif. et 3 (25 %) avaient hmilaryngectomie vertical. Un patient a avait document rcidive de la tumeur et un est dcd d'autres causes tout gratuit du cancer. Dans la priode post- op 2 (16%) patients ont dvelopp des fistules pharyngo-cutane. Post- op radiothrapie n'tait pas disponible. Tous les patients sont rentrs chez eux sans problmes avec un rgime alimentaire, les soins de stomie ou d'hygine. Dispositifs lectrolarynx ont t fournis pour la restauration de la voix. Conclusion: laryngectomie est une composante importante de la formation chirurgicale en Afrique. Il est ncessaire pour la parole et de la dglutition thrapeutes pour le counselling pr - opratoire et la radaptation post-opratoire ainsi que pour la radiothrapie. MAXILLECTOMY AT MBINGO BAPTIST HOSPITAL, NORTHWEST CAMEROON Acha Everistus Tikum, Wayne M. Koch, Tony Mwenyemali, Richard Bardin Mbingo Baptist Hospital, Cameroon Abstract Background: Performance of maxillectomy requires advanced surgical skill making resident training difficult. Perioperative management is also demanding. This service is rarely available in the developing world. Methods: We reviewed the records of Mbingo Baptist Hospital (MBH) for maxillectomies performed between 2008 and 2013. The study was approved by the IRB of MBH. Results: All procedures involved general surgery residents from the Pan African Academy of Christian Surgeons (PAACS) program. Patients included 7 women and 6 men ages 17 to 83 years (mean 50 years). Work-up included CT scans when available, and incisional or fine-needle aspiration biopsy. Cases included a variety of processes including 5 malignant lesions, 5 benign neoplasms, and 3 inflammatory or undetermined conditions. The approach of surgery was tailored to the histology and extent of tumor. The resulting cavity was managed by packing with gauze and referral to a dentist for fabrication of an obturator. There were no major post-operative complications. All patients resumed a liquid diet on POD #2 and advanced diet as tolerated. Patients who could not be fit with an obturator tolerated oral diet intake with minimal complaint of discomfort or nasal regurgitation. Three patients were referred for postoperative radiation therapy. We have documented (1) recurrence (pleomorphic adenoma) for which the patient underwent re-resection. There have been no deaths in this series of patients. Conclusion: Maxillectomy can be performed and taught in Africa referral hospitals. Patients can resume oral intake with or without rehabilitation using dental obturators. MAXILLECTOMIE A MBINGO BAPTIST HOSPITAL, DU NORD-OUEST CAMEROUN Contexte: Performance de maxillectomie ncessite des comptences chirurgicales de pointe offrant de la formation rsident difficile. Prise en charge priopratoire est aussi exigeante. Ce service est rarement disponible dans le monde en dveloppement. Mthodes: Nous avons revu les dossiers de l'hpital baptiste Mbingo (MBH) pour maxillectomies ralises entre 2008 et 2013 L' tude a t approuve par l'IRB de MBH . Rsultats: Toutes les procdures impliques rsidents de chirurgie gnrale de l'Acadmie panafricaine des programmes (PAACS) chrtiens chirurgiens. Les patients inclus 7 femmes et 6 hommes gs de 17 83 ans (moyenne 50 ans) . Travail -up inclus tomodensitomtrie lorsqu'ils sont disponibles, et l'incision ou l'aiguille fine biopsie . Les cas inclus une varit de processus dont 5 lsions malignes, tumeurs bnignes , 5 et 3 conditions inflammatoires ou indtermin . L'approche de la chirurgie a t adapt l'histologie et l'tendue de la tumeur. La cavit rsultant a t gre par l'emballage avec de la gaze et renvoi un dentiste pour la fabrication d'un obturateur. Il n'y avait pas de complications post-opratoires majeures . Tous les patients ont repris une alimentation liquide sur POD # 2 et l'alimentation de pointe comme tolr . Les patients qui ne pouvaient pas tre en forme avec un obturateur tolrs apport alimentaire orale avec un minimum d'inconfort plainte ou nasale rgurgitation . Trois patients ont t rfrs pour la radiothrapie postopratoire. Nous avons document (1 ) rcidive (adnome plomorphe ) pour lesquels le patient a subi une re- rsection. Il n'ya eu aucun dcs dans cette srie de patients. Conclusion: Maxillectomie peut tre ralise et a enseign en Afrique hpitaux de rfrence. Les patients peuvent reprendre la prise orale avec ou sans l'aide d' obturateurs rhabilitation dentaires . Confrencier: Acha Everistus Tikum, MD Mbingo Cameroun TEACHING HEAD AND NECK SURGERY TO GENERAL SURGICAL RESIDENTS IN CAMEROON AND ETHIOPIA Wayne Koch, Jason Chan, Ryan Li, Acha Everistus Tikum Mbingo Baptist Hospital, Cameroon Abstract Background: The Pan African Academy of Christian Surgeons (PAACS) trains African General Surgery residents in referral mission hospitals in 7 African countries. Each program has at least two general surgery faculty members, and care is provided to patients with a very wide array of surgical conditions. Subspecialty topics such as head and neck (H&N) surgery are included in the curriculum with training augmented by visiting surgeon-educators. Methods: We have explored curriculum development for H&N surgical training of general surgery residents through a survey of ten current residents in two programs, Mbingo Baptist Hospital (MBH) in Northwest Cameroon and Soddo Christian Hospital (SCH) in Ethiopia. Survey results are analyzed in conjunction with cases performed by one visiting H&N surgeon during a total of 8 visits over a span of 4 months. Consideration of the volume of cases required for clinical competency as well as ideal structure of training rotation for H&N within the general surgery program are presented. Results: Resident survey respondees list head and neck and facial reconstructive surgery as the areas of greatest importance to them in anticipating their caseload upon graduation. Procedures of greatest interest include thyroidectomy, tracheotomy, foreign body extraction, neck dissection, parotidectomy, deep space neck infection and management of facial skeletal trauma. Conclusion: Current caseloads at MBH and SCH provide adequate volume for thyroidectomy and facial skeletal trauma, but adequate availability of teaching other procedures will require increased time with subspecialty faculty. 116 ENSEIGNEMENT HEAD AND NECK SURGERY AUX RESIDENTS DE CHIRURGIE GENERALE AU CAMEROUN ET EN THIOPIE L'Acadmie panafricaine des chirurgiens chrtiens (PAACS) forme des rsidents de chirurgie gnrale de l'Afrique dans les hpitaux de la mission d'orientation dans 7 pays africains. Chaque programme a au moins deux membres du corps professoral de chirurgie gnrale, et les soins sont prodigus aux patients avec un trs large ventail de conditions chirurgicales. Sujets de sous-spcialits telles que la tte et du cou (H & N) chirurgie sont inclus dans le programme de formation augmente en visitant chirurgien - ducateurs . Nous avons explor l'laboration de programmes pour H & N formation chirurgicale des rsidents en chirurgie gnrale travers une enqute de dix rsidents actuels dans deux programmes, Hpital Mbingo Baptiste (MBH) au nord-ouest du Cameroun et Christian Hospital Soddo (PPB ) en Ethiopie . Les rsultats du sondage sont analyss conjointement avec les cas effectue par l'une visite H & N chirurgien pendant un total de 8 visites sur une priode de 4 mois. Examen du volume d'affaires requis pour la comptence clinique ainsi que la structure de rotation idale de formation pour H & N dans le programme de chirurgie gnrale sont prsents. Tte de liste des rpondants ayant rpondu l'enqute rsident et le cou et la chirurgie reconstructive du visage comme les zones de plus grande importance pour les anticiper leur charge de l'obtention du diplme. Procdures de plus grand intrt comprennent thyrodectomie, trachotomie, l'extraction d'un corps tranger, un curage ganglionnaire, parotidectomie, espace lointain infection du cou et de la gestion des traumatismes du squelette facial . Cas des charges de courant au MBH et SCH offrent un volume adquat pour une thyrodectomie et traumatismes du squelette facial, mais une disponibilit suffisante de l'enseignement d'autres procdures auront besoin de temps augmente avec facult de sous- spcialit. OTOGENIC TETANUS: CONTINUING CLINICAL CHALLENGE IN THE DEVELOPING COUNTRY S.A OGUNKEYEDE*1, A. J FASUNLA1, A. A ADEOSUN1 AND O .A LASISI1 1Otorhinolaryngology Department, University College Hospital, Ibadan Abstract Background: Otogenic tetanus is a vaccine preventable disease which continues to be of public health significance.The objective is to evaluate patients with otogenic tetanus and identify the factors that predisposes patients to it. Methodology: This is a 16-year retrospective review of all patients managed for otogenic tetanus at the Department of Otorhinolaryngology, University College Hospital, Ibadan. The essential clinical data collected include demographic data, clinical presentations, tetanus immunization history, duration of hospital admission, management and outcome. Results: There were 66 subjects made up of 45 (68.2%) males and 21 (31.8%) females. Their age ranged between 2 and 65years, mean of 7.7 years but the under 5years constituted the majority, 56.1%. All patients presented with ear discharge, lock jaw and spasms. The onset of symptoms ranged between 3 and 8 days with a mean of 4.3 3.3days. Only 21.2% had history of completed childhood tetanus immunisation. No patient had booster shots. About 98% had history of use of herbs, charcoal, honey, cigarette, methylated spirit or deodorant in the discharging ear. All were managed with antibiotic ear dressing, tetanus toxoid, human tetanus immunoglobulin, antibiotic therapy and sedative but only 3% had airway management. The duration of hospital admission ranged from 18 days to 105 days and there were 12.1% death. Conclusion: Otogenic tetanus is still a major problem in developing countries and this can be prevented if recommended childhood tetanus vaccination and booster shots regimen are properly taken. Health education on ear hygiene and care of the ear may prevent this disease. Key words: Preventable disease, Discharging ear, Immunization, Otogenic tetanus and developing country. PLASTIC SURGERY EDUCATION IN THE USA AND GHANA: THEIR SIMILARITIES AND DIFFERENCES 1 W. Bradford Rockwell, 2Pius Agbenorku Institution: 1Division of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA; 2Reconstructive Plastic Surgery and Burns Unit, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana CORRESPONDENCE:  HYPERLINK "mailto:brad.rockwell@hsc.utah.edu" \h brad.rockwell@hsc.utah.edu Abstract Background: The need for plastic surgery training is paramount in contributing to the needs of persons who need to change or improve on their body outlook and function. Plastic surgery education entails a lot and requires expertise of persons who have much experience in the field to be able to handle all cases they encounter. Countries such as the USA and Ghana have made strides in providing persons requesting the need for surgeries such as various reconstructive plastic surgeries, repair of congenital deformities amongst others.The current study seeks to compare the plastic surgery training in Ghana with the program in the USA focusing on the similarities and differences, and improving both. Methods: Training programs in plastic surgery training in Ghana and in the USA were reviewed by the available training protocols and via the internet and also contacting various specialists who had undergone these programs. Results: Plastic surgery education and training programs differ in Ghana and in the USA and yet have some similarities. Conclusion: The current study reveals some similarities in plastic surgery training in Ghana and the USA even though some differences do exist. Plastic surgery is costly and not all persons can afford to undergo the surgeries they require. For this reason government institutions, charity organizations and philanthropists should all be encouraged to provide funds to support the training and also persons in need of surgery. L'EDUCATION DE LA CHIRURGIE PLASTIQUE DANS LES ETATS-UNIS ET LE GHANA : LEURS SIMILITUDES ET LEURS DIFFERENCES W. Bradford Rockwell. Email : brad.rockwell @ hsc.utah.edu RSUM Contexte: La ncessit d'une formation de chirurgie plastique est primordiale pour contribuer aux besoins des personnes qui ont besoin de changer ou d'amliorer leurs perspectives et fonctions de l'organisme . L'ducation de la chirurgie plastique 117 ncessite beaucoup et ncessite des comptences des personnes qui ont beaucoup d'exprience dans le domaine pour tre en mesure de traiter tous les cas qu'ils rencontrent . Des pays comme les Etats-Unis et le Ghana ont fait des progrs dans la fourniture de personnes demandant la ncessit pour les chirurgies telles que diverses chirurgies plastiques de reconstruction , la rparation des malformations congnitales chez les autres. Objectif: La prsente tude vise comparer la formation de chirurgie plastique au Ghana avec le programme aux Etats-Unis en mettant l'accent sur ?les similitudes et les diffrences , et amliorer la fois . Mthodes: les programmes de formation en matire de formation de chirurgie plastique au Ghana et aux Etats-Unis ont t examines par les protocoles de formation disponibles et via Internet et en communiquant avec galement divers spcialistes qui avaient subi ces programmes . Rsultats: les programmes d' ducation et de formation chirurgie plastique diffrer au Ghana et aux tats-Unis et n'ont pas encore quelques similitudes . Conclusion: L' tude rvle certaines similitudes dans la formation de la chirurgie plastique au Ghana et les Etats-Unis , mme si des diffrences existent. La chirurgie plastique est coteuse et non toutes les personnes peuvent se permettre de subir les interventions chirurgicales dont ils ont besoin . Pour cette raison, les institutions gouvernementales, les organisations caritatives et les philanthropes devraient tous tre encourags fournir des fonds pour soutenir la formation et aussi les personnes dans le besoin de la chirurgie . UNIVERSITY-BASED INTERNATIONAL PLASTIC SURGERY COLLABORATION BUILDS LOCAL SUSTAINABILITY 1 W. Bradford Rockwell, 2Pius Agbenorku Institution: 1Division of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA; 2Reconstructive Plastic Surgery and Burns Unit, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana CORRESPONDENCE:  HYPERLINK "mailto:brad.rockwell@hsc.utah.edu" \h brad.rockwell@hsc.utah.edu Abstract Background: Surgical services are recognized as essential to the health of populations. To increase the availability of plastic surgical care, it is postulated that there are 3 main approaches: direct supply of services, increasing the availability of existing services through financial support, and increasing the quantity and capacity of existing services through education. Education has the greatest level of sustainability. The plastic surgery faculty at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana and the University of Utah in the USA have formed an international educational collaboration which will build sustainability in plastic surgery care in Ghana. Methods: The program involves yearly visits from the Utah faculty and residents. Resident to resident interaction introduces another beneficial level of education and understanding. The education is a two way process. The teaching faculties of both institutions identify several educational topics in advance as areas of concentration for the visit. Lectures and clinical cases concentrate on these topics. In addition to the in person visits, the internet is used to record and transmit conferences and to discuss clinical cases. Conclusion: We have implemented a program that focuses on education at a medical school and residency training level. The local population receives clinical care as a component of the education effort but not as the primary focus. Education is imparted to all members of the plastic surgery team faculty, residents and students. Recurring visits and internet exchange during the year forge perpetual relationships. Sustainability of plastic surgery care and education is maximized. UNIVERSITE BASED INTERNATIONAL PLASTIC SURGERY COLLABORATION FAVORISE LA VIABILITE LOCALE W. Bradford Rockwell Email : brad.rockwell @ hsc.utah.edu Abstract Introduction: Les services de chirurgie sont reconnus comme essentiels pour la sant des populations . Pour augmenter la disponibilit des soins chirurgicaux en plastique , il est postul que , il ya 3 grandes approches : l'offre directe de services , d'accrotre la disponibilit des services existants par un soutien financier , et l'augmentation de la quantit et de la capacit des services existants grce l'ducation . L'ducation a le plus haut niveau de durabilit. La facult de chirurgie plastique l'hpital Komfo Anokye (KATH) Kumasi , au Ghana et l'Universit de l'Utah aux tats-Unis ont form une collaboration internationale de l'ducation qui va construire la durabilit des soins de chirurgie plastique au Ghana.Format ducation Le programme comprend des visites annuelles de la facult et les rsidents de l'Utah . Rsident l'interaction rsident introduit un autre niveau bnfique de l'ducation et de la comprhension . L' ducation est un processus double sens . Le corps enseignant des deux institutions identifier plusieurs thmes ducatifs l'avance que les zones de concentration de la visite. Des confrences et des cas cliniques se concentrent sur ces sujets . En plus des visites en personne, Internet est utilis pour enregistrer et transmettre des confrences et pour discuterde cas cliniques. Conclusion: Nous avons mis en place un programme qui met l'accent sur ?l?'ducation une cole de mdecine et le niveau de formation en rsidence. La population locale reoit des soins cliniques comme une composante de l'effort de l'ducation, mais pas comme le principal. L'ducation est communique tous les membres de l'quipe de chirurgie plastique - professeurs, rsidents et tudiants. Visites priodiques et d'change Internet au cours de l'anne nouent des liens perptuels. Durabilit des soins de chirurgie plastique et de l'ducation est maximise. BURN INJURIES IN SIERRA LEONE: A POPULATION -BASED ASSESSMENT 1,2,3Evan G. Wong, 3,4Reinou S. Groen, 5,6Thaim B. Kamara, 7Laura D. Cassidy, 7Mohamed Samai, 1Dan L. Deckelbaum, 1Tarek Razek, 2,3,8Adam L. Kushner, 9Sherry M. Wren 1Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada; 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;3Surgeons OverSeas (SOS), New York, NY, USA; 4Department ofGynecology and Obstetrics,Johns Hopkins Hospital,Baltimore, MD, USA; 5Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; 6College of Medicine and Allied Health Science (COMAHS), Freetown, Sierra Leone; 7Institute for Health and Society, and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA;8Department of Surgery, Columbia 118 University, New York, New York, USA;9Department of Surgery, Stanford University School of Medicine, Stanford, California, USA CORRESPONDENCE: Evan Wong, Department of Surgery, McGill University, 1650 Cedar Avenue, L9 411, Montreal, QC, Canada, H3G 1A4, E-mail:  HYPERLINK "mailto:evan.wong@mail.mcgill.ca" \h evan.wong@mail.mcgill.ca Abstract Background: Burn injuries remain disproportionately prevalent in developing countries. This study aims to describe the epidemiology of thermal injuries in Sierra Leone to serve as a baseline for future programs. Methods: A cluster randomized, cross-sectional, countrywide survey was conducted in 2012 in Sierra Leone. Household member demographics and deaths during the previous 12 months were assessed using a standardized questionnaire. Two randomly selected household members were then interviewed, elucidating whether participants had ever had a burn injury in six body regions and determining burn mechanisms and patterns of health care seeking behavior. Results: This study included 1843 households and 3645 individuals. A total of 4.0% (145/3645) of individuals reported at least one current or previous burn injury. The highest proportions of burns were reported in participants aged 0-4 years old (23/426, 5.4%) and 5-14 years old (37/887, 4.2%). The majority of burns (129/145, 89.0%) were caused by a hot liquid/object and the upper extremities were the most commonly burned body regions, involved in 36% (53/145) of cases. Of all participants who suffered a thermal injury, 21% (30/145) sought care from a traditional healer. Conclusion: Burn injuries are highly prevalent in Sierra Leone. Further research and resources should be allocated to the care and prevention of thermal injuries. Rsum Contexte: Brler les blessures demeurent disproportionne rpandues dans les pays en dveloppement . Cette tude vise dcrire l'pidmiologie des blessures thermiques en Sierra Leone pour servir de base pour de futurs programmes . Mthodes: Une tude randomise en coupe transversale , l'enqute en grappes , le pays a t mene en 2012 en Sierra Leone . La dmographie des membres du mnage et de dcs au cours des 12 mois prcdents ont t valus l'aide d'un questionnaire standardis. Deux membres de la famille, choisis au hasard ont ensuite t interrogs, lucider si les participants avaient dj eu une brlure dans six rgions du corps et de dterminer les mcanismes et les modles de soins de sant les comportements de recherche brlures. Rsultats: Cette tude a inclus 1 843 mnages et 3645 personne. Un total de 4,0% ( 145/3645 ) des personnes ont dclar au moins un des brlures ou actuelle . Les plus fortes proportions de brlures ont t signals chez les participants gs de 0-4 ans (23/ 426, 5,4%) et 5-14 ans (37/ 887, 4,2% ) . La majorit des brlures (129/145 , 89,0% ) ont t causs par un liquide / objet chaud et les membres suprieurs taient rgions du corps les plus souvent brles , impliqus dans 36 % ( 53/145 ) des cas. De tous les participants qui ont subi une blessure thermique, 21 % (30/ 145) cherch des soins auprs d'un gurisseur traditionnel. Conclusions: Brlures sont trs rpandus en Sierra Leone. Des recherches et des ressources devraient tre alloues aux soins et la prvention des blessures thermiques. DEVELOPING AN ADVANCED AIRWAY COURSE IN AN AFRICAN SETTING-OUR EXPERIENCE Iyun A.O, Michael A.I, Olawoye O.A, Ademola S.A, Oluwatosin O.M Department of Plastic Surgery, University College Hospital , Ibadan, Nigeria Abstract Background: Inhalation injury is a major cause of morbidity and mortality in patients with major burns. About 80% of patients with inhalation injury that we manage in our environment die. Many factors are responsible for these including the limited experience of the burn unit staff in managing these patients, inadequate ventilator support and lack of coordinated interdisciplinary approach to the management. The aim of this presentation is to highlight our experience with development and organization of the Advanced Airway Support for patients with inhalation injury course in other to improve patient management and outcomes. Methods: A one day course which is open to burn care providers who have done a basic life support course was developed. It includes lectures and practicals on bronchoscopy and endotracheal intubation. The resource p e r s o n s i n c l u d e p l a s t i c s u r g e o n s , anaesthetist,otorhinolaryngologist and cardiothoracic surgeons. Manikins are used for demonstrations and there is hands-on bronchoscopy practice in the endoscopy suite with visual aids. Results: Four courses have held since September 2009. 47 burn care providers have been trained, a 98 page book published, definitive airway care protocol instituted and there has been better collaboration and multidisciplinary care of patients with inhalation injury. Drawbacks include inadequate facilities for adequate airway support and patient centered concerns such as funding. Conclusion: Training and retraining in airway care is essential for burn care providers in other to improve patient outcomes. Sustaining and translating the course to improved outcome in patients with inhalation injury remains a big challenge, which requires further evaluation. Dvelopper une Airway Cours avanc dans un Africain cration de notre exprienc Blessures Introduction-L'inhalation est une cause majeure de morbidit et de mortalit chez les patients atteints de brlures graves. Environ 80 % des patients atteints de lsions par inhalation que nous grons dans notre environnement mourir. De nombreux facteurs sont responsables de ces questions, notamment l'exprience limite du personnel de l'unit de brlure dans la gestion de ces patients , l'assistance ventilatoire insuffisante et le manque d' approche interdisciplinaire coordonne de la gestion . Le but de cette prsentation est de mettre en valeur notre exprience dans le dveloppement et l'organisation de la "Airway Support avanc pour les patients atteints inhalation cours de blessures "dans d'autres pour amliorer la gestion et les rsultats des patients Mthode -A cours d'une journe qui est ouvert brler les fournisseurs de soins qui ont fait un cours de base de soutien de la vie a t dvelopp . Il comprend des cours magistraux et travaux pratiques sur la bronchoscopie et l'intubation 119 endotrachale. Les personnes ressources sont des chirurgiens plasticiens , anesthsiste , ORL et chirurgiens cardiothoraciques . Mannequins sont utiliss pour des dmonstrations et il ya des exercices pratiques de la bronchoscopie dans la salle d'endoscopie avec des aides visuelles Rsultats - Quatre cours ont lieu depuis Septembre 2009. 47 fournisseurs de soins de brlure ont t forms , un livre de 98 pages publi , dfinitif protocole de soins des voies respiratoires en place et il ya eu une meilleure collaboration et prise en charge multidisciplinaire des patients atteints de lsions par inhalation . Les inconvnients comprennent des installations de soutien des voies respiratoires adquat et centrs sur le patient des proccupations telles que l'insuffisance du financement. Conclusion. Formation et de recyclage dans les soins des voies respiratoires est essentiel pour les fournisseurs de soins de brlure dans les autres pour amliorer les rsultats des patients .Le maintien et la traduction de cours l'amlioration des rsultats chez les patients prsentant une lsion par inhalation demeure un grand dfi qui ncessite une valuation plus pousse . OVERGROWTH OF THE LIMBS; A PROSPECTIVE STUDY OF 21 GHANAIAN PATIENTS Emmanuel J K Adu, Institution: Department of Surgery, School of Medical Sciences, KNUST, Kumasi, Ghana CORRESPONDENCE:  HYPERLINK "mailto:aduemmanuel@hotmail.com" \h aduemmanuel@hotmail.com Abstract Background: Overgrowth or gigantism is a congenital pathological enlargement of the soft tissue parts of a limb, with associated enlargement of the skeleton. There is overgrowth of one or more cell types. It may be associated with lipofibromatosis, neurofibromatosis, hyperostosis, or hemihypertrophy. Surgical management aims to relieve functional symptoms and to improve upon the cosmetic appearance. METHODS: A prospective study from January 2005 to December 2009 was undertaken at Komfo Anokye Teaching hospital in Kumasi to document the prevalence and management of patients presenting with congenital enlargement of a limb or digit. The patients were examined clinically and the site of enlargement was recorded. X-rays, pre- and postoperative photographs were taken. Surgical procedures performed included debulking, ray reduction, and ray amputation. Results: 21 patients presented with overgrowth of the limbs during the study period, made up of nine males and 12 females, giving a male to female ratio of 1: 1.33. Their ages ranged from 0.33 to 15 years, with a mean age of 7.57 years; median age of 7.63 years with a standard deviation of 4.92. 28 sites were involved: 16 involving the upper limb; 12 involving the lower limb. 16 limbs on the right side and 12 on the left side were affected. The hand was the most affected site (28.7%); followed by the foot (14.28%). The big toe was the most affected digit (10.71%). Debulking was the commonest procedure (71.43%), followed by ray reduction (17.14%) and ray amputation (11.43%) Conclusion: Overgrowth of the limbs can cause significant morbidity to patients. Children who present early with mild enlargement can be treated by debulking and epiphysiodesis to arrest skeletal growth. Patients presenting in late childhood require extensive debulking, ray reduction and ray amputation. SURCROISSANCE des membres; une tude prospective de 21 patients GHANEN Introduction Surcroissance ou gigantisme est un largissement pathologique congnitale des parties de tissus mous d'un membre, de l'largissement correspondant du squelette. Il existe une prolifration d'un ou plusieurs types de cellules. Il peut tre associ lipofibromatosis, la neurofibromatose, h y p e r o s t o s e , o u h m i h y p e r t r o p h i e . Le traitement chirurgical vise soulager les symptmes fonctionnels et amliorer l'aspect esthtique. Patients et mthodes Une tude prospective de Janvier 2005 Dcembre 2009 a t entrepris Komfo Anokye hpital de Kumasi documenter la prvalence et la gestion des patients prsentant un largissement congnitale d'un membre ou chiffres. Les patients ont t examins cliniquement et le site de l'largissement a t enregistre. Rayons X, photographies pr- et post-opratoires ont t prises. Les procdures chirurgicales effectues inclus debulking, la rduction des rayons , et l'amputation des rayons . Rsultats patients prsentaient une prolifration des membres au cours de la priode d'tude , compos de neuf hommes et 12 femmes , soit un rapport de masculinit de 1 : 1,33 . Leur ge variait de 0,33 15 ans, avec un ge moyen de 7,57 ans; ge mdian de 7,63 ans, avec un cart-type de 4,9228 sites sont concerns : 16 impliquant le membre suprieur ; 12 impliquant le membre infrieur . 16 membres sur le ct droit et 12 sur le ct gauche ont t touchs. La main a t le site le plus touch ( 28,7% ), suivie par le pied ( 14,28% ) . Le gros orteil tait le chiffre le plus touchs (10,71 % de ) Chirurgie de rduction a t la procdure la plus frquente ( 71,43 %), le suivi de la rduction des rayons ( 17,14 %) et l'amputation de rayons ( 11,43% ) Conclusion Prolifration des membres peut entraner une morbidit significative pour les patients. Les enfants qui prsentent au dbut de l'largissement doux peuvent tre traites par rduction tumorale et piphysiodses pour arrter la croissance du squelette. Les patients prsentant la fin de l'enfance exigent beaucoup de rduction tumorale, la rduction des rayons et l'amputation des rayons. MANAGEMENT OF GROSSLY ENLARGED BREASTS IN A TERTIARY HOSPITAL IN A DEVELOPING COUNTRY: A LONG TERM REVIEW 1,,2 Agbenorku P, 1,2Akpaloo J, 2Farhat B, 2Agyei F Institution: 1Reconstructive Plastic Surgery & Burns Unit, Komfo Anokye Teaching Hospital, Ghana; 2School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana CORRESPONDENCE:  HYPERLINK "mailto:pimagben@yahoo.com" \h pimagben@yahoo.com Abstract Background: Breast hypertrophy, though quite rare, is well pronounced in some females. Reduction mammaplasty or sub-cutaneous mastectomy is often employed in treatment of 120 this condition. This study seeks to find out the long-term level of satisfaction of surgery on these persons after about 1 5 years after treatment. Methods: From January 2007 to December 2012, the Komfo Anokye Teaching Hospital (KATH) carried out surgeries on 31 females who presented with several degrees of breast hypertrophy. They answered questionnaires on their condition pre-operatively and post-operatively at the time of the review process. Results: Eighty-four percent out of the 31 treated were available for the review. All the patients said there was 100% relief of the pain they felt in the neck, upper and lower back regions. There was no re-occurrence of the condition in any of the patients; 88% stated they were satisfied and that their new breast size(s) were excellent for them. Conclusion: The pre-operative complications experienced by these patients were resolved; thus the surgical procedure was good resulting in the improvement in the quality of life of these persons. Titre de l'article : GESTION DES SEINS GROSSIEREMENT ELARGIES DANS UN HOPITAL DE SOINS TERTIAIRES DANS UN PAYS EN DEVELOPPEMENT : LE LONG PARCOURS RSUM Introduction: Hypertrophie mammaire , bien que trs rare , est bien marque dans certaines femelles . Plastie mammaire de rduction ou une mastectomie sous-cutane est souvent utilis dans le traitement de cettecondition. Objectif: Cette tude vise dterminer le niveau long terme de satisfaction de la chirurgie sur ces personnes aprs environ 1 - 5 ans aprs le traitement. Matriels et Mthodes: De Janvier 2007 to Dcembre 2012, le CHU Anokye Komfo (KATH) effectues chirurgies sur 31 femmes qui se sont prsents avec plusieurs degrs d'hypertrophie mammaire . Ils ont rpondu des questionnaires sur leur tat pr -opratoire et post-opratoire au moment du processus d'examen. Rsultats: Quatre-vingt- quatre pour cent de la 31 traits taient disponibles pour l'examen. Tous les patients ont dit qu'il y avait 100 % d'allgement de la douleur qu'ils se sentaient dans le cou, le haut et le bas du dos rgions . Il n'y avait pas la rapparition de la maladie dans l'un des patients, 88 % ont dclar qu'ils taient satisfaits et que leur nouvelle taille (s) du sein tait excellentpour eux. Conclusion: Les complications propratoires rencontrs par ces patients ont t rsolues ; ainsi la procdure chirurgicale a t bonne pour rsultat l'amlioration de la qualitde vie de ces personnes. OROFACIAL CLEFT OUTREACH IN RURAL GHANA: ANY POSITIVE IMPACT ON THE COMMUNITY? 1,2Agbenorku P, 3Agbenorku M, 1Hoyte-Williams P.E. 1Reconstructive Plastic Surgery & Burns Unit, Komfo Anokye Teaching Hospital, Ghana; 2School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Health Education Unit, Global Evangelical Mission Hospital, Apromase-Ashanti, Ghana CORRESPONDENCE:  HYPERLINK "mailto:pimagben@yahoo.com" \h pimagben@yahoo.com Abstract Background: Orofacial clefts (OFC) are common congenital malformations in humans. They impact negatively on the life of the affected; they are often considered as stigma in the society especially among the rural folks.This study was to analyzeretrospectively the cases managed by a Ghanaian indigenous plastic surgery outreach team and prospectively outline the social impacts on the lives of those treated and their communities. Methods: The study reviewed the medical records of patients treated during OFC outreaches in rural Ghana from January 2003 to December 2012 (10 years), visiting and interviewing patients contacted and their parents/relatives, interviewing the community leaders: chiefs, assemblymen, church leaders, etc. using structured pretested questionnaires within 5 days (September 1 5, 2013) in communities in south-east of Ghana. Results: A total of32 outreach services were handled over the 10 year period, treating 303 OFC patients (among other pathologies), comprising 175 (57.8%) males and 128 (42.2%) females; 158 (5.1%) of them were located and interviewed; 65 community/opinion leaders/relatives interviewed. Sixty-one percent of the females and 48% of the males got married after the surgery; 83% of the school going-age patients continued and completed basic schools. Stigmatization and psychological effects on them were removed; they were well accepted in their societies and family gatherings. Conclusion: OFC outreaches helped to restore the lives and dignity to cleft patients and their families; they play worthy roles in their communities since nobody scorns them any longer thereby removing all social and negative psychological effects from them. SENSIBILISATION FENTE OROFACIALE AU GHANA RURAL: TOUT IMPACT POSITIF SUR LA COMMUNAUTE? LES AUTEURS ET LEURS AFFILIATIONS RSUM Prsentation: Orofacial fentes (OFC) sont des malformations congnitales courantes chez les humains . Ils ont un impact ngatif sur la vie des personnes touches, ils sont souvent considrs comme la stigmatisation dans la socit, notamment parmi les populations rurales . Objectif: Cette tude a t d'analyser rtrospectivement les cas grs par une quipe nationale ghanenne de plastique chirurgie de sensibilisation et de prospective dcrire les impacts sociaux sur la vie des personnes traites et leurs communauts. Mthodes: L'tude a examin les dossiers mdicaux de patients traits au cours des portes de l'OFC en milieu rural au Ghana partir de Janvier 2003 to Dcembre 2012 ( 10 ans) , en visitant et en interrogeant les patients contacts et leurs parents / parents , en interrogeant les dirigeants de la communaut : chefs, lus parlementaires, des chefs religieux , etc en utilisant des questionnaires pr-tests structurs dans les 5 jours ( Septembre 1 - 5 , 2013) dans les communauts dans le sud- est du Ghana . Rsultats: Un total de 32 services de proximit ont t traites au cours de la priode de 10 ans , le traitement de 303 patients de l'OFC ( entre autres pathologies ) , comprenant 175 ( 57,8 %) hommes et 128 ( 42,2 %) des femmes ; 158 ( 5,1% ) d'entre eux taient situs et interrogs ; 65 dirigeants communautaires / opinion / parents interrogs . Soixante et un pour cent des femmes et 48 % des hommes se sont maris aprs la chirurgie ; 83 % des patients en ge d'tre scolariss poursuivi et achev les coles primaires. La stigmatisation et les effets psychologiques sur eux ont t enlevs, ils ont t bien acceptes dans la socit et les runions de famille . Conclusion: outreaches OFC a contribu restaurer la vie et de la dignit des patients et de leurs familles livre, ils jouent des rles dignes dans leurs communauts puisque personne ne les ddaigne plus longtemps en supprimant tous les effets psychologiques et sociaux ngatifs de leur part. 121 EPIDEMIOLOGY OF MAXILLOFACIAL FRACTURES SEEN AT KORLE BU TEACHING HOSPITAL, GHANA OVER THIRTEEN YEARS Grace Parkins, Isaac Nuamah, Matthew Owusu Boamah, Dominic Avogo Department of Oral and Maxillofacial Surgery, Korle-Bu Teaching Hospital, Accra, Ghana.  HYPERLINK "mailto:gparkins@chs.edu.gh" \h CORRESPONDENCE: HYPERLINK "mailto:gparkins@chs.edu.gh" \h gparkins@chs.edu.gh Abstract Background: Maxillofacial fractures continue to engage the attention of surgeons worldwide. The incidence however varies from country to country. The dominant aetiology also tends to have a global variation.The aim of this study is to investigate the epidemiological trend of jaw fractures at Korle- Bu Teaching Hospital (KBTH), Ghana over 13 years. METHODS: Patients who were referred to the Department of Oral and Maxillofacial Surgery with injuries to the head and neck region from January 2000 to December 2012 had their clinical details summarized on flash cards. These were then transferred to a computer database program (Microsoft Excel*). The data was cleaned then analyzed. RESULTS: There were in all 1790 patients. 1628 of them had hard tissue injury and 162 only soft tissue injury. 735 had both hard and soft tissue injuries. Male to female ratio was 3.5:1. Men 21 to 30 years of age sustained the most fractures (31.75%). Most fractures were as a result of RTA (54.79%). The mandible was the commonest anatomical site of fracture (60.93%).More than 60% were treated by closed reduction and intermaxillary fixation. Complications occurred in 6.39% of patients. Concomitant injuries occurred in 26.1% of the patients of which most were injuries to the lower limbs. 1.5% of the patients did not survive their injuries. CONCLUSION: The study emphasizes the trauma pattern within the country and the importance of adopting measures to improve road safety. The results are consistent with the global pattern. RSUM Contexte: fractures maxillo-faciale continuent de retenir l'attention des chirurgiens du monde entier . L'incidence varie cependant d'un pays l'autre. L'tiologie dominante tend aussi avoir une variation globale. Le but de cette tude est d'tudier l'volution pidmiologique des fractures de la mchoire l'hpital Korle Bu Teaching (KBTH) le Ghana plus de 13 ans. Mthodes: Les patients qui ont t renvoys au ministre de la chirurgie buccale et maxillo-faciale avec des blessures la tte et du cou partir de Janvier 2000 to Dcembre 2012 affiche les dtails cliniques rsums sur des cartes flash . Ceux-ci ont ensuite t transfrs dans un programme de base de donnes informatique ( Microsoft Excel * ) . Les donnes ont t analyses ensuitenettoys. Rsultats: Il y avait dans les 1790 patients. 1628 d'entre eux avaient des blessures des tissus durs et 162 seulement des blessures des tissus mous. 735 avaient des lsions des tissus durs ou tendres. Ratio hommes-femmes tait de 3,5:1 . Hommes de 21 30 ans ont subi le plus de fractures (31,75 %). La plupart des fractures ont t par suite de RTA (54,79 %) . La mandibule a t le site anatomique la plus frquente de fracture (60,93 % de). Plus de 60 % ont t traits par rduction ferme et fixation intermaxillaire. Des complications sont survenues dans 6,39% des patients. Blessures concomitantes se sont produites dans 26,1 % des patients dont la plupart taient des blessures aux membres infrieurs. 1,5% des patients n'ont pas survcu leurs blessures. Conclusion: Cette tude met l'accent sur le modle de traumatisme dans le pays et l'importance d'adopter des mesures visant amliorer la scurit routire. Les rsultats sont en accord avec le modle global. PATTERN AND DISTRIBUTION OF ANOMALIES OF TOOTH NUMBER IN GHANAIANS: A RADIOGRAPHIC ASSESSMENT KakrabahQuarshie C A, Newman Nartey M, Amoah K G Dept. of Orthodontics and Paedodontics, University of Ghana Dental School Abstract Background: Hypodontia is one of the prevalent anomalies in the developing dentition. Together with hyperdontia, they are more common in the permanent than in the primary dentition and may occur in isolation or as a feature as a syndrome. Although asymptomatic, they may cause functional, aesthetic and psychological problems.The purpose of this study was to assess the distribution and pattern of abnormalities of tooth number in the permanent dentition of patients attending the University of Ghana Dental School Clinic. Methods: In this study, a total of 79 panoramic radiographs of subjects aged 8 16 years were studied and examined for hypo and hyperdontia. The data was recorded and then analysed using SPSS-16.0 version. Results Hypodontia (70.9%) was more common than hyperdontia (29.1%). There were 120 congenitally missing teeth in 56 panoramic radiographs. Congenitally missing teeth were more common in females (53.6%) than in males (46.4%). When comparing the maxilla to the mandible, a greater number of congenitally missing teeth were found in the maxilla (56.7%) and in the right side of both jaws (53.3%). The most observed hypodontia type was mild to moderate hypodontia (two to five missing teeth). The third molars were the most congenitally missing teeth (33.3%) followed by mandibular second premolars and the maxillary lateral incisors with identical frequencies of 15.8%. Next came the maxillary second bicuspids (14.2%), the mandibular central incisors (9.2%) then the maxillary first premolar (4.2%) in decreasing frequencies. The missing teeth were mostly bilateral (62.5%). There were a total of 44 supernumerary teeth. Similar to congenitally missing teeth, there was a higher frequency of supernumerary teeth found in females (56.5%), in the maxilla (59.1%) and in the right side of the jaws (54.5%).Most supernumerary teeth were observed in the premolar region (40.9%, n=18) and there were more commonly unilateral. Conclusion: In this population, hypodontia was more common than hyperdontia. Both congenitally missing teeth and supernumerary teeth tended to occur more commonly in females, in the maxilla and on the right side of the jaws. Upon the exclusion of third molars, the most frequent congenitally missing teeth were the mandibular second premolars and the maxillary lateral incisors. The most frequent supernumerary teeth were paramolars associated with premolars and mesiodens were the least frequent. MODELE ET DISTRIBUTION DE ANOMALIES DE NOMBRE DE DENTS DANS LES GHANEENS : UNE EVALUATION RADIOGRAPHIQUE RSUM CONTEXTE: Hypodontie est l'une des anomalies rpandues dans la dentition en dveloppement . Avec hyperdontia, ils sont plus frquents dans la permanente que dans la dentition primaire et peuvent survenir isolment ou comme une option 122 comme un syndrome. Bien asymptomatiques, elles peuvent causer des problmes fonctionnels , esthtiques et psychologiques . OBJECTIFS: Le but de cette tude tait d'valuer la rpartition et la structure des anomalies du nombre de dents dans la dentition permanente des patients qui frquentent l'Universit du Ghana Clinique dentaire scolaire. Matriels et mthodes: Dans cette tude , un total de 79 radiographies panoramiques de sujets gs de 8 - 16 ans ont t tudis et examins pour hypo et hyperdontia . Les donnes ont t enregistres puis analyses avec le logiciel SPSS - 16.0 Version. RSULTATS: hypodontie (70,9 %) tait plus frquente que hyperdontia (29,1% ) . Il y avait 120 absence congnitale de dents dans 56 radiographies panoramiques. Absence congnitale de dents ont t plus frquents chez les femmes (53,6 %) que chez les hommes ( 46,4 %) . Lorsque l'on compare le maxillaire la mandibule, un plus grand nombre de absence congnitale de dents ont t trouvs dans le maxillaire (56,7 %) et dans la partie droite des deux mchoires ( 53,3 %) . Le type de hypodontie plus observe tait d'intensit lgre modre hypodontie (deux cinq dents manquantes) . Les troisimes molaires sont les dents les plus congnitalement absente (33,3 %), suivie par les deuximes prmolaires mandibulaires et des incisives latrales maxillaires avec des frquences identiques de 15,8%. Viennent ensuite les prmolaires deuxime (14,2%) , les incisives centrales infrieures (9,2%) , puis la premire prmolaire maxillaire (4,2% ) dans la diminution des frquences . Les dents manquantes taient principalement bilatrale (62,5 % ) . Il y avait un total de 44 dents surnumraires. Semblable absence congnitale de dents, il y avait une plus grande frquence des dents surnumraires trouvs chez les femmes ( 56,5 %) , dans le maxillaire ( 59,1% ) et dans le ct droit de la mchoire ( 54,5 %) . La plupart des dents surnumraires ont t observes dans la rgion prmolaire ( 40,9 %, n = 18) et il y avait plus communment unilatrale CONCLUSION: Dans cette population , hypodontie tait plus frquente que hyperdontia . Les deux absence congnitale de dents et les dents surnumraires ont tendance se produire plus souvent chez les femmes, dans le maxillaire et sur ?l?e ct droit de la mchoire . l'exclusion des troisimes molaires, les plus frquents absence congnitale de dents ont t les deuximes prmolaires mandibulaires et des incisives latrales maxillaires. Les dents surnumraires les plus frquents taient paramolars associs aux prmolaires et mesiodens taient les moins frquents. A SURVEY OF THE KNOWLEDGE OF ORTHODONTICS AS A DENTAL SPECIALTY AMONG UNIVERSITY OF GHANA MEDICAL SCHOOL STUDENTS Newman-Nartey MA, Osei-Tutu K, Ogunbanjo BO, and Adegbite KO CORRESPONDENCE:  HYPERLINK "mailto:kofident@yahoo.com" \h kofident@yahoo.com Abstract Backgropund: There is increasing awareness by the general population, of Orthodontic conditions like malocclusion as made evident in the increased need to have these conditions treated. A cursory look at referrals made by Medical Doctors to Dental practitioners however, shows a paucity of referrals requiring Orthodontic specialist attention. The objective of this study is to ascertain the level of Knowledge of Orthodontics among University of Ghana Medical School Students. Methods: The questionnaire was self administered to the participants after pre testing them on 25 students. The number of students on campus at the time of the study was about 450. A total of 130 questionnaires were administered out of which 18 were discarded because they were incompletely filled. As far as possible, the questionnaires were administered to the students before lectures and collected immediately. Frequency distribution was generated for all variables and measures of central tendency obtained for all numerical variables. Results: More than half of the participants had heard of the term Orthodontics (57.1%). However, only 35.7% and 32.1% correctly explained who an Orthodontist was, and what an Orthodontist did respectively. Conclusion: The medical students in this survey did not have adequate levels of knowledge and would therefore benefit from tailored introductory lectures that specifically address dental specialties including orthodontics. KEY WORDS: Orthodontics as a dental specialty, Medical Students, Orthodontic knowledge UNE ENQUETE SUR LES CONNAISSANCES DE L'ORTHODONTIE COMME UNE SPECIALITE DENTAIRE DES ETUDIANTS DE L'UNIVERSITE MEDICAL SCHOOL GHANA RSUM objectif: Il est de plus en plus conscience par la population en gnral , des conditions d'orthodontie comme malocclusion rendu vident dans le besoin accru d'avoir ces conditions traits . Cependant, un coup d'il sur les rfrences faites par les mdecins pour les praticiens dentaires montre un manque de rfrences ncessitant l'attention de spcialiste en orthodontie. L'objectif de cette tude est d'valuer le niveau de connaissances de l'orthodontie chez Universit du Ghana mdicale lves de l'cole. Matriels et mthodes: Le questionnaire a t administr auto aux participants aprs pr les tester sur 25 tudiants . Le nombre d'tudiants sur le campus au moment de l'tude tait d'environ 450 . Un total de 130 questionnaires ont t administrs dont 18 ont t rejets parce qu'ils ont t partiellement remplis. Autant que possible , les questionnaires ont t administrs aux lves avant confrences et prlevs immdiatement . Distribution de frquence a t gnr pour toutes les variables et les mesures de tendance centrale obtenus pour toutes les variables numriques rsultats:Plus de la moiti des participants avaient entendu p a r l e r d e s O r t h o d o nt i e L g i s l at u re ( 5 7 , 1 % ) gVirt_NP_NN_NNPS< . Cependant, seulement 35,7 % et 32,1% correctement expliqu qui tait un orthodontiste, et ce un orthodontistefait respectivement . conclusion: Les tudiants en mdecine dans cette enqute n'ont pas un niveau adquat de connaissances et seraient donc bnficier de cours d'introduction sur mesure qui rpondent spcifiquement spcialits dentaires, y compris l'orthodontie. Mots cls: Orthodontie une spcialit dentaire , les tudiants en mdecine , les connaissances orthodontique. 123 THE IMPACT OF LOCALIZATION OF CLINICAL DENTAL TRAINING ON THE BRAIN DRAIN OF DENTAL SURGEONS IN GHANA Newman-Nartey MA Dept. of Orthodontics and Paedodontics, University of Ghana Dental School CORRESPONDENCE:  HYPERLINK "mailto:merleynn@hotmail.com" \h merleynn@hotmail.com Abstract Background: Training of dental surgeons in Ghana commenced in 1974 when the University of Ghana admitted the first batch of ten students to undergo preclinical university training in dentistry. Although the facilities of the University of Ghana Medical School was adequate for the preclinical dental training in Ghana, the country lacked the clinical facilities to support the full clinical dental training. This necessitated special arrangements with Dental schools in the United Kingdom and Nigeria to admit the Ghanaian dental students into their clinical programms. After over two decades of clinical training abroad, clinical dental training was localized in Ghana in 1993. This study reviews the two clinical training programs and their impact on the Ghanaian economy and the development of dentistry in Ghana. METHODS: Data on all the dental graduates from the University of Ghana were obtained from the archives of the University of Ghana Dental School and analyzed The current location of each of the graduates were obtained from the documents of the Ministry of Health. RESULTS: The results show that the cost of training abroad was very expensive and yet only a small number of the dental surgeons trained overseas returned to Ghana to offer oral healthcare to Ghanaians. On the other hand, training of dental surgeons locally, is inexpensive and the number of dental surgeons has increased significantly since the inception of clinical dental training in Ghana CONCLUSION: Localization of clinical dental training in Ghana has had a significant impact on the economy of this nation and the development of the dental profession. L'IMPACT DE LA LOCALISATION DE LA FORMATION DENTAIRE CLINIQUE SUR LA FUITE DES CERVEAUX DE CHIRURGIENS DENTISTES AU GHANA introduction La formation des chirurgiens-dentistes au Ghana a commenc en 1974, lorsque l'Universit du Ghana a reconnu le premier lot de dix tudiants de suivre une formation universitaire prclinique en dentisterie. Bien que les installations de l' universit de l'cole mdicale du Ghana tait adquate pour la formation dentaire prclinique au Ghana , le pays ne disposait pas des installations cliniques l'appui la formation clinique dentaire complet . Cela a ncessit des arrangements spciaux avec les coles dentaires au Royaume-Uni et le Nigeria pour admettre les tudiants en mdecine dentaire ghanens dans leurs programms cliniques. Aprs plus de deux dcennies de formation clinique l'tranger , la formation dentaire clinique a t localis au Ghana en 1993 . Cette tude passe en revue les deux programmes de formation clinique et leur impact sur l'conomie ghanenne et le dveloppement de la mdecine dentaire au Ghana. mthodes Les donnes sur tous les diplms en mdecine dentaire de l'Universit du Ghana ont t obtenus partir des archives de l'Universit de l'cole dentaire Ghana et analyses La position actuelle de chacun des diplms ont t obtenues partir des documents du ministre de la Sant . rsultats Les rsultats montrent que le cot de la formation l'tranger tait trs cher et pourtant seulement un petit nombre de chirurgiens-dentistes forms l'tranger de retour au Ghana pour offrir des soins dentaires aux Ghanens . D'autre part , la formation des chirurgiens-dentistes au niveau local , est peu coteux et le nombre de chirurgiens-dentistes a augment de manire significative depuis le dbut de la formation dentaire clinique au Ghana conclusionLocalisation de la formation dentaire clinique au Ghana a eu un impact significatif sur l'conomie de cette nation et le dveloppement de la profession dentaire . POSTGRADUATE TRAINING IN GHANA, THE RESIDENT'S PERSPECTIVE Newman-Nartey MA, Buckman V A Dept. of Orthodontics and Paedodontics, University of Ghana Dental School CORRESPONDENCE:  HYPERLINK "mailto:merleynn@hotmail.com" \h merleynn@hotmail.com Abstract Background: The Ghana College of Physicians and Surgeons (GCPS) was mandated by an Act of Parliament to commence the training of specialist doctors in various fields of Medicine and Dentistry in 2003. As the College celebrates 10 years of Residency training in Ghana, it is the opportune time to assess the achievements and the shortfalls of this monumental health development in this country. This study sought to ascertain the factors that have influenced residency training from the viewpoint of the current trainee specialists. Methods: 117 trainee specialists were included in this cross sectional longitudinal study. Data was recorded and analyzed using SPSS Results: The study showed that 51.3% were satisfied with the contact time with supervisors, whereas only 33.9% were satisfied with didactic teaching and less (17.2%) were satisfied with research work. Majority of the respondents (92%) felt that the duration of the program was adequate. The major challenges faced by residents included; excessive clinical workload (47.2%), lack of didactic teaching (16%) and inadequate contact time with supervisors (12.3%). The study showed that majority of the respondents were not satisfied with research based training and didactic teaching and felt the need for these components to be improved upon in the program. Conclusion: The results from this study suggest that there is a need for a review of teaching methods in Specialist Training at the GCPS to improve upon engagement of Residents. Adequate funds should also be set aside to encourage research and its dissemination at Local and International conferences FORMATION POSTDOCTORALE EN GHANA, DU POINT DE VUE DE LA RSIDENCE . INTRODUCTION Le Collge ghanen des mdecins et chirurgiens (GCP ) a t mandat par une loi du Parlement de commencer la formation de mdecins spcialistes dans les diffrents domaines de la m d e c i n e e t d e d e n t i s t e r i e e n 2 0 0 3 . Comme le Collge clbre 10 ans de formation en rsidence au Ghana , c'est le moment opportun pour valuer les ralisations et les lacunes de ce dveloppement de la sant monumentale 124 dans ce pays . Cette tude visait dterminer les facteurs qui ont influenc la formation des rsidents du point de vue des spcialistes de stagiaires actuels. MTHODE 117 spcialistes en formation ont t inclus dans cette tude longitudinale en coupe transversale . Les donnes ont t enregistres et analyses avec le logiciel SPSS RSULTATS L'tude a montr que 51,3 % taient satisfaits de la dure de contact avec les superviseurs, alors que seulement 33,9 % taient satisfaits de l'enseignement didactique et moins (17,2% ) taient satisfaits de travaux de recherche . La majorit des rpondants (92%) estime que la dure du programme tait adquat. Les principaux dfis auxquels font face les rsidents inclus , charge de travail excessive clinique ( 47,2 % ) , le manque d' enseignement didactique ( 16 % ) et le temps de contact insuffisant avec les superviseurs ( 12,3% ) . L'tude a montr que la majorit des rpondants n'taient pas satisfaits de la formation de recherche et d'enseignement en fonction didactique et a senti le besoin de ces composants tre amliores dans le programme. CONCLUSION Les rsultats de cette tude suggrent qu'il existe un besoin pour un examen des mthodes d'enseignement en spcialiste de la formation la GCPS amliorer l'engagement des rsidents. Des fonds suffisants doivent galement tre mis de ct pour encourager la recherche et sa diffusion des confrences locales et internationales ALCOHOL AND DRUG USE AMONG DENTAL STUDENTS IN KNUST: A PRELIMINARY STUDY Martin Tettey, F Adu-Ababio, Joseph Abu-Sakyi Dental Unit, College of Health, Kintampo, Ghana, Dental School KNUST, Kumasi, Ghana, Dental Clinic, University Hospital, KNUST, Kumasi.  HYPERLINK "mailto:tetteydent@gmail.com" \h tetteydent@gmail.com Abstract Objective: A preliminary investigation into alcohol and drug use among dental students in Kwame Nkrumah University of Science & Technology (KNUST), Kumasi, Ghana. Methods: Structured questionnaires were administered to pre- clinical and clinical (1st to 6th) year dental students on their use of alcohol, tobacco, cannabis, heroin and cocaine. After obtaining the appropriate ethical clearance, the study population (n=112) were encouraged to answer the questionnaires. Respondents were assured of the confidentiality of their responses and their anonymity was guaranteed. Data was analyzed using SPSS version 16.0. Results: Response rate was 84.8% (95 out of 112 subjects).Undergraduate dental students engaged in drug use in a decreasing order; Alcohol 44.2%, Tobacco 15.8%, Cannabis 7.4%, Heroin 5.3%. No student reported cocaine use. Alcohol and drug use according to gender was not analyzed in the current study.Reasons for alcohol and drug use wereto celebrate happy events (45.3%) and special occasions (41.1%).Negative effects of drug indulgence included absenteeism (35.8%), financial problems (30.5%), relationship breakdown (24.2%) and low grades in school (22.1%). Conclusions: Alcohol was most frequently abused and heroin was the least used drug. However, cocaine abuse was not reported by the study participants. Further studies involving large study subjects will have to be carried out in order to arrive at definitive conclusions and also to make recommendations to regulate alcohol and drug use by undergraduate dental students at KNUST. Key words: Alcohol, Drug use, Dental students. OBJECTIVE ASSESSMENT OF BLOOD LOSS BY SKILLED BIRTH ATTENDANTS IN NNEWI, SOUTHEAST NIGERIA Mbachu II1, Udigwe GO2, Adinma JIB2, EZEAMA C 2 Department of Obstetrics and Gynaecology, Imo State University, Owerri Department of Obstetrics and Gynaecology, NnamdiAzikiwe University, Nnewi. Correspondence: Dr Mbachu II. E-mail:  HYPERLINK "mailto:imbachu@yahoo.com" \h imbachu@yahoo.com Abstract Background: Postpartum haemorrhage is the leading direct cause of maternal mortality and near miss maternal morbidities. Accurate estimation of blood loss is very crucial in making the diagnosis of postpartum haemorrhage and in its management. Different methods of blood loss estimation at delivery have been described. However, they all have their drawbacks in clinical settings. Visual estimation remains the commonly used method despite its inaccuracy in estimating blood loss during delivery. Assessment of predetermined blood volume by healthcare providers is important in determining the discrepancy and ways of improving visual estimation of blood loss. Methods: The discrepancy between actual blood loss and estimated blood loss was determined by simulation. The predictors of accurate estimation were also determined. Subjects and methods: This was a prospective observational study conducted at NnamdiAzikiwe University Teaching Hospital Nnewi, Nigeria. Doctors and nurses that work in the labour ward were recruited for the study. Clinical scenarios were created using predetermined blood volume in an objectively structured examination (OSCE) fashion. Individuals observed blood volume at different clinical stations and recorded their results. Statistical analysis was done using SPSS version 20. The mean error of estimation for each group was determined. ANOVA was used to explore relationship between mean error of estimation among professional groups and years of practice as a doctor or nurse. Paired t-test was used to compare the first and second arms of the study. Results: One hundred and fifty-six subjects participated in the first arm of the study. Only the one hundred and forty four that completed the second arm of the study was in the analysis. In the first arm, there was significant underestimation of blood loss in all the stations. The second arm of the study showed significant reduction in the mean error of estimation in six of the eight stations, there was no statistical correlation between mean error of estimation, professional and the number of years of practice Conclusion: Visual estimation of blood loss is inaccurate in estimation of blood loss. Education by simulation using clinical scenarios improves the visual estimation of blood loss. Key words: Blood loss estimation, objective, simulation, VALUATION OBJECTIVE DE LA PERTE DE SANG PAR ACCOUCHEUSES QUALIFIEES NNEWI, SUD NIGERIA. ABSRTACT Contexte: l'hmorragie du post-partum est la principale cause directe de la mortalit maternelle et la morbidit maternelle prs de Mlle. Une estimation prcise de la perte de sang est trs important pour faire le diagnostic 125 d'hmorragie du post-partum et sa gestion. Diffrentes mthodes d'estimation de la perte de sang lors de l'accouchement ont t dcrits . Cependant , ils ont tous leurs inconvnients dans les milieux cliniques . L'estimation visuelle reste la mthode couramment utilise malgr son imprcision dans l'estimation de la perte de sang pendant l'accouchement. valuation du volume de sang prdtermine par les fournisseurs de soins de sant est important dans la dtermination de la diffrence et des moyens d'amliorer l'estimation visuelle de la perte de sang. But et objectifs : L'cart entre la perte de sang rel et la perte de sang estim a t dtermin par simulation. Les facteurs prdictifs d'estimation prcise a galement t dtermine. Sujets et mthodes: Il s'agissait d'une tude observationnelle prospective mene l'Universit Nnamdi Azikiwe enseignement Hpital Nnewi , Nigria . Les mdecins et les infirmires qui travaillent dans la salle de travail ont t recruts pour l'tude. Scnarios cliniques ont t crs en utilisant un volume de sang prdtermine un examen objectif structur (ECOS) de la mode. Les individus observs volume de sang dans les stations cliniques diffrents et ont enregistr leurs rsultats. L'analyse statistique a t tre fait en utilisant la version SPSS 20. L'erreur moyenne d' estimation pour chaque groupe a t dtermine. ANOVA a t utilise pour explorer la relation entre l'erreur moyenne d'estimation des groupes professionnels et des annes de pratique comme un mdecin ou une infirmire. Le test t appari a t utilis pour comparer les premier et second bras de l'tude. Rsultats: Cent cinquante-six sujets ont particip la premire de l'tude. Seule la 144 qui a achev le deuxime bras de l'tude tait l'analyse . Dans la premire branche , il y avait une sous-estimation significative de la perte de sang dans l'ensemble des stations . Le second volet de l'tude a montr une rduction significative de l'erreur moyenne d'estimation dans six des huit stations , Il n'y avait pas de corrlation statistique entre l'erreur moyenne d'estimation , professionnel et le nombre d'annes de pratique Conclusion : Visual estimation de la perte de sang est inexacte dans l'estimation de la perte de sang . ducation par la simulation en utilisant des scnarios cliniques amliore l ' e s t i m a t i o n v i s u e l l e d e l a p e r t e d e s a n g . Mots cls : perte de sang estimation , objectif , simulation INTRAPARTUM PERINEAL INJURIES AMONG WOMEN IN AKWAPIN SOUTH MUNICIPALITY, GHANA Jessie Appiagyei1, Emmanuel Morhe2, Henry S Opare- Addo2 Holy Family Nursing Training College, Nkawkaw, Ghana Department of Obstetrics and Gynaecology, KomfoAnokye Teaching Hospital and Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Correspondence: Emmanuel Morhe.  HYPERLINK "mailto:eskmorhe@yahoo.com" \h eskmorhe@yahoo.com Abstract Background: Everyday many women suffer varied degrees of vaginal birth associated pelvic floor and perineal trauma; some live with debilitating sequelae. The extent of problem vary and least studied in developing countries. This study determined the pattern and reported sequelae of intrapartum lacerative perinealinjuriesamongwomenin Akwapin South Municipality. Methodology This was a population based cross-sectional survey of 384 women who delivered in Akwapim South Municipality between June 1st 2007 and May 31st 2009. Respondents, selected from 24 communities were interviewed by trained midwives in their homes. Variables studied included demographic and reproductive characteristics; place of delivery, types of intrapartumperineal lacerations suffered and reported sequelae. Using Stata version 9.0 the data were summarized using descriptive statistics. Association between reported sequelae and lacerative perineal injury was examined using univariate and multivariable logistic regression analyses at 95% confidence interval and 5% level of significance. Results: The mean age was 25.5 (SD 0.1) years. Most (63.2%) respondents completed basic level of education, 49.0% were primiparous and 36.7% had last delivery with Traditional Birth Attendants. A total of 724 birth experiences were reported. Of these 338 (60.2%) occurred in hospitals and clinics, 333(46.0%) were associated with spontaneous perineal tears, 207(28.6%) with episiotomy and 184 (25.4%) no perineal lacerations. Reported sequelae included incontinence of urine, gas or faeces; dyspareunia; and reduced coital pleasure. Incontinence of gas was significantly associated with lacerative perineal injury (p-value <0.001). Conclusion: Many women in Akwapim South district seek labour and delivery with traditional birth attendants. Many, experience lacerative intrapartumperineal injuries. Various sequelae including incontinence of gas, dyspareunia and reduced sexual pleasure have been reported among the women studied. FondTous les jours de nombreuses femmes souffrent des degrs varis de naissance vaginale plancher pelvien associ et les traumatismes du prine ; certains vivent avec des squelles invalidantes . L'tendue du problme varie et moins tudi dans les pays en dveloppement. Objectif Cette tude a dtermin la structure et a rapport des squelles de blessures prinales lacration partum chez les femmes dans Akwapin Sud municipalit. MthodologieIl s'agissait d'une enqute transversale base sur la population de 384 femmes qui ont accouch dans Akwapim Sud municipalit entre le 1er Juin 2007 et le 31 mai 2009.Les rpondants, slectionns partir de 24 communauts ont t interrogs par les sages-femmes formes dans leurs maisons. Variables tudies comprenaient les caractristiques dmographiques et la reproduction; lieu de livraison, les types de dchirures prinales partum souffert et ont rapport des squelles . En utilisant Stata version 9.0 les donnes ont t rsumes l'aide de statistiques descriptives. Association entre les squelles et les blessures rapportes prinale lacration a t examin par rgression logistique univarie et multivarie analyse 95 % d'intervalle de confiance et le niveau de signification de 5 % . Rsultats L'ge moyen tait de 25,5 ( SD 0,1 ) ans . La plupart ( 63,2 %) des rpondants complt le niveau d'ducation de base , 49,0 % taient des primipares et 36,7 % avaient la dernire livraison avec les accoucheuses traditionnelles . Un total de 724 expriences d'accouchement ont t signals. Parmi ceux-ci 338 ( 60,2% ) a eu lieu dans les hpitaux et les cliniques , 333 ( 46,0% ) taient associs des dchirures du prine spontanes , 207 ( 28,6%) avec pisiotomie et 184 ( 25,4% ) aucun dchirures prinales . Squelles publies inclut l'incontinence d'urine, de gaz ou de matires fcales ; dyspareunie, et rduit le plaisir du cot . Incontinence de gaz a t significativement associe une lsion lacration prinale (p -value < 0,001) . ConclusionBeaucoup de femmes dans le district de Akwapim Sud cherchent travail et l'accouchement avec des accoucheuses traditionnelles. Beaucoup, exprience lacration dchirures prinales intra-partum . Divers squelles, y compris l'incontinence de gaz, la dyspareunie et le plaisir sexuel rduite ont t rapports chez les femmes tudies. 126 KNOWLEDGE AND PRACTICE OF EXCLUSIVE BREASTFEEDING AMONG ANTENATAL ATTENDEES IN UYO, SOUTHERN, NIGERIA *Aniekan M Abasiattai, **Etiobong A Etukumana, ***EnoNyong ****Ukeme E Eyo *Department of Obstetrics/Gynaecology, University of Uyo, Uyo, Nigeria. **Department of Family Medicine, University of Uyo, Uyo, Nigeria. ***Department of Paediatrics, University of Uyo, Uyo, Nigeria. ****Department of Physical and Health Education, University of Uyo, Uyo, Nigeria. Correspondence author: DrAniekan MAbasiattai, Department of Obstetrics/Gynaecology, University of Uyo, Uyo. E-mail:  HYPERLINK "mailto:animan74@yahoo.com" \h animan74@yahoo.com Abstract Objective: To assess the knowledge and practice of exclusive breastfeeding among women receiving antenatal care in a tertiary hospital in Southern Nigeria. Methods: Semi-structured questionnaires were distributed by trained resident doctors to two hundred women in the antenatal clinic of the University of Uyo Teaching Hospital. Data analysis was done withEpi-info 3.2.2 CDC Atlanta Georgia USA statistical soft ware. Results: Majority of the respondents (69.5%) was between 25- 34 years of age, 57.0% were multiparous and 67.7% had attained tertiary level education. Eighty-four women (42.0%) were able to define exclusive breastfeeding correctly while just 7.0% of the respondents knew the ten steps to successful breastfeeding. Only 44.5% of the women practiced exclusive breastfeeding. None of the women belonged to a breastfeeding support group and the most common source of information on exclusive breastfeeding was the antenatal health talks (81.0%). Conclusion: This study reveals that the level of knowledge and practice of exclusive breastfeeding by women in our centre is poor. There is need for large scale health enlightenment of members of the public on exclusive breastfeeding. There is also the need for periodic retraining of relevant health workers on the practice of exclusive breastfeeding and strategies introduced forits regular monitoring and evaluation. Key words: Exclusive breastfeeding; antenatal attendees; Southern Nigeria; Uyo Rsum Objectif: valuer les connaissances et la pratique de l'allaitement maternel exclusif chez les femmes recevant des soins prnatals dans un hpital de soins tertiaires dans le sud du Nigeria . Mthodologie: semi-structures questionnaires ont t distribus par les mdecins rsidents forms deux cents femmes dans la clinique prnatale de l'Hpital universitaire de Uyo enseignement. L'analyse des donnes a t ralise avec Epi -info 3.2.2 CDC Atlanta Georgia USA de soft ware statistique. Rsultats: La majorit des rpondants (69,5 %) avaient entre 25-34 ans , 57,0% taient multipares et 67,7 % avaient un niveau de formation de niveau tertiaire . Quatre-vingt- quatre femmes (42,0 %) ont t en mesure de dfinir l'allaitement maternel exclusif correctement alors que seulement 7,0% des rpondants connaissaient les tapes de dix pour un allaitement russi. Seulement 44,5 % des femmes pratiqu l'allaitement maternel exclusif. Aucune de ces femmes appartenaient un groupe de soutien l'allaitement et la source la plus commune de l'information sur l'allaitement maternel exclusif tait les pourparlers de sant prnatals (81,0%) de. Conclusion: Cette tude rvle que le niveau de connaissance et la pratique de l'allaitement maternel exclusif par les femmes dans notre centre est pauvre. Il est ncessaire pour l'illumination de la sant grande chelle de membres du public sur l'allaitement maternel exclusif. Il ya aussi la ncessit d'un recyclage priodique des agents de sant concerns sur la pratique de l'allaitement maternel exclusif et stratgies mis en place pour son suivi et son valuation rgulire. SEROPREVALENCE OF HEPATITIS B SURFACE ANTIGEN IN PREGNANT WOMEN AND UMBILICAL CORD BLOOD ANTIGENAEMIA IN INFANTS OF SEROPOSITIVE WOMEN AT UNIVERSITY OF ILORIN TEACHING HOSPITAL OGUNLAJA, Olumuyiwa Ayotunde. FAWOLE, Adegboyega Adisa, University of Ilorin Teaching Hospital, Ilorin, Nigeria. Corresponding Author- Dr. FAWOLE, AdegboyegaAdisa,University of Ilorin Teaching Hospital, Ilorin.Nigeria.  HYPERLINK "mailto:faafaa2005@yahoo.com" \h faafaa2005@yahoo.com Background: A study on the seroprevalence of Hepatitis B surface Antigen in the sub-Saharan region is of public health importance because existing studies show an intermediate to high seroprevalence of hepatitis B surface Antigen in the region; hence, the far reaching consequences associated with these pose a significant health burden to the population at large. The aim of this study is to determine the prevalence rate of HBV infection amongst pregnant women. The vertical transmission rate at birth in the University of Ilorin Teaching Hospital. Methods: This is a prospective study in which both booked and unbooked pregnant women were recruited after obtaining an informed consent. This was a qualitative study done using immunochromatographic test strips to determine seropositivity of HBV or its absence. Results: Seroprevalence rate of HBV was found to be 12.7%, which is in the high endemic range. The vertical transmission occured in 40% of the neonates of seropositive mothers. Conclusion: There is a high seroprevalence rate of HBsAg which translates to high HBV infection in the community. Affected infants even carry more burden, therefore the golden standard is prevention. It is therefore recommended that routine screening for HBV be included into the list of routine antenatal investigations for all pregnant women in the University Of Ilorin Teaching Hospital and the community at large. Health care providers and policy makers are advised to strengthen the existing mass immunization program, improve the screening of blood and blood products and recognize the sociodemographic, economic and sociocultural risk factors in order to be able to design an effective prevention program. If this is done satisfactorily, it will contribute significantly towards the attainment of MDGs 4&5. 127 SEROPREVALENCE DE L'HEPATITE B ANTIGENE DE SURFACE CHEZ LES FEMMES ENCEINTES ET LE CORDON OMBILICAL ANTIGENEMIE DE SANG CHEZ LES ENFANTS DE FEMMES SEROPOSITIVES A L'UNIVERSITE D'ILORIN HOPITAL D'ENSEIGNEMENT. Une tude sur la sroprvalence de l'hpatite B antigne de surface dans la rgion sub -saharienne est d'une importance pour la sant publique parce que les tudes existantes montrent un intermdiaire forte sroprvalence de l'hpatite B antigne de surface dans la rgion , d'o les lourdes consquences associes ces pose un fardeau important pour la sant de la population en gnral. objectif Le but de cette tude est de dterminer le taux de prvalence de l'infection par le VHB chez les femmes enceintes . Le taux de transmission verticale la naissance de l'Universit de l'Hpital Ilorin enseignement . mthodes Il s'agit d'une tude prospective dans laquelle les deux rserves et les femmes enceintes non attendues ont t recruts aprs l'obtention d'un consentement clair . Il s'agissait d'une tude qualitative effectue l'aide des bandelettes de test immunochromatographique pour dterminer la sropositivit de l'hpatite B ou de son absence. rsultats Taux de sroprvalence du VHB a t retrouv 12,7 %, ce qui est dans la gamme forte endmicit. La transmission verticale est survenue chez 40% des nouveau-ns de mres sropositives. conclusion Il ya un taux de sroprvalence de l'AgHBs qui se traduit l'infection par le VHB leve dans la communaut. Les nourrissons atteints portent mme plus lourde, donc la rgle d'or est la prvention. Il est donc recommand que le dpistage de routine pour le VHB tre inclus dans la liste des enqutes prnatales de routine pour toutes les femmes enceintes l'Hpital universitaire de Ilorin enseignement et la communaut au sens large. Fournisseurs de soins de sant et les dcideurs sont invits renforcer le programme de vaccination de masse existant , amliorer le contrle de sang et de produits sanguins et de reconnatre les facteurs de risque sociodmographiques , conomiques et socioculturelles afin d'tre en mesure de concevoir un programme de prvention efficace . Si cela est fait de manire satisfaisante, il contribuera de manire significative la ralisation des OMD 4 et 5. CONTRACEPTIVE USE AMONG HIV POSITIVE WOMEN IN ENUGU, SOUTH EAST NIGERIA Euzebus Chinonye Ezugwu, Nkwo Peter O, Agu Polycap Uche, Ugwu Emmanuel Onyebuchi, Asogwa Augustine O. Department of Obstetrics & Gynecology, University of Nigeria Teaching Hospital, Ituku- Ozalla, Enugu state, Nigeria. Corresponding Author- EzugwuEuzebus C. E-mail:  HYPERLINK "mailto:ezugwueuzebus@yahoo.com" \h ezugwueuzebus@yahoo.com Abstract Background: The use of contraception for the prevention of unintended pregnancy among HIV infected women is an effective strategy recommended by WHO in its four pronged approach for comprehensive prevention of mother to child transmission (PMTCT) of HIV. The objective is to determine the contraceptive prevalence and pattern of use among HIV positive women in Enugu, southeastern Nigeria. Methods: A cross-section of 400 consecutive HIV positive, sexually active women receiving care at the adult HIV clinics of two tertiary health institutions in Enugu were interviewed using pre tested questionnaires. Statistical analysis was both descriptive and inferential using the Epi info statistical software version 3.3.1. p value of less than 0.05 was considered statistically significant. Results: The contraceptive prevalence rate was 73.1%, while 26.9% (n=91) of the participants were not on any modern contraceptives. Male condom was the commonest contraception used (78.1%, n=193),with 48.2% of them reporting inconsistent use. The prevalence of dual contraceptive method was 25.1%; none used female condom. Having a regular sexual partner was significantly associated with use of modern contraception (OR: 73.00; 95% CI: 34.13- 156.13; p < 0.001). Misconception and the fear of side effect were the commonest reason for not using contraceptives. Conclusion: A significant proportion of HIV positive women in Enugu (26.9%) have unmet need for contraception. This high unmet need could militate against the fight for PMTCT of HIV. The use of contraception prevents unintended pregnancy and subsequently mother to child transmission of HIV and should be promoted in the region. L'UTILISATION DE CONTRACEPTIFS PARMI LES FEMMES SEROPOSITIVES A ENUGU, SUD EST DU NIGERIA Rsum Introduction: L'utilisation de la contraception pour la prvention des grossesses non dsires chez les femmes infectes par le VIH est une stratgie efficace recommand par l'OMS dans son approche en quatre volets pour la prvention globale de transmission mre-enfant (PTME ) du VIH . Objectif: dterminer la prvalence de la contraception, motif de son utilisation et le corrlat de l'utilisation de la contraception chez les femmes sropositives Enugu, dans le sud du Nigeria. Mthodes: une section de 400 femmes sexuellement actives conscutifs positifs pour le VIH , reoivent des soins aux adultes cliniques du VIH de deux tablissements de sant tertiaires Enugu ont t interrogs l'aide de questionnaires pr tests . L'analyse statistique a t la fois descriptive et infrentielle utilisant le Epi info version du logiciel statistique La valeur de p infrieure 0,05 tait considre comme statistiquement significative. Rsultat: le taux de prvalence contraceptive tait de 73,1 %, tandis que 26,9 % (n = 91) des participants n'taient pas sur les contraceptifs modernes . Prservatif masculin tait la contraception le plus utilis (78,1 %, n = 193) , 48,2 % d'entre eux dclarent avoir consomm incompatible . La prvalence de la double mthode de contraception tait de 25,1 % ; aucun utilis prservatif fminin. Avoir un partenaire sexuel rgulier tait significativement associe l'utilisation de la contraception moderne (OR : 73,00 ; IC 95% : de 34,13 156,13, p < 0,001) . Ide fausse et la crainte d'effets secondaires taient la raison la plus courante pour ne pas utiliser des contraceptifs. Conclusion: Une proportion importante de femmes sropositives Enugu (26,9 % ) ont des besoins non satisfaits en matire de contraception . Ce besoin non satisfait pourrait militer contre la lutte pour la PTME du VIH. L'utilisation de la contraception empche les grossesses non dsires et la suite de la transmission mre-enfant du VIH et devrait tre encourage dans la rgion. 128 ANTISEPTIC SKIN PREPARATION FOR PREVENTING SURGICAL SITE INFECTION AT CAESAREAN SECTION: A RANDOMISED CONTROL TRIAL Aworinde OO1*, Orji EO1, Adeyemi AB1, Olufemi-Aworinde KJ2 Department of Obstetrics & Gynaecology, ObafemiAwolowo University Teaching Hospitals' Complex, Ile-Ife, Osun State, Nigeria Department of Haematology and Blood Transfusion, ObafemiAwolowo University Teaching Hospitals' Complex, Ile-Ife, Osun State, Nigeria Corresponding author: OlufemiAworinde;aworindeolufemi@yahoo.com; Abstract Objective: The aim of this randomised control trial was to compare the effect of two different antiseptic skin preparations; chlorhexidine-alcohol and povidone iodine on surgical site infection rates after caesarean section and to determine the rate of skin reactions to both antiseptic skin preparation. Methods: A total of 374 patients (188 in the chlorhexidine- alcohol group and 186 in the povidone iodine group) who had elective caesarean section with no overt risk factor for surgical site infection were recruited. They underwent caesarean section based on the same technique. A proforma was designed to collect information on sociodemographic and obstetric characteristics and neonatal outcome. Patients were contacted at intervals up to thirty days from delivery, to assess symptoms and signs of surgical site infection and they were treated as appropriate. Results: Fifty-one (13.6%) of the total study population developed surgical site infection. There was however no statistically significant difference between the chlorhexidine- alcohol group and the povidone iodine group (12.2% vs 15.1%; p=0.26). Thirty seven (66.7%) of the SSI was of the superficial type and the most cultured organism was Staphylococcus aureus. Chlorhexidinealcohol had a lower adverse skin reaction profile than povidone iodine (4.0% vs 5.4%; p=0.40). The skin reaction seen were pruritus and erythema with none being life threatening. Conclusion: This prospective study demonstrates that antisepsis with chlorhexidine-alcohol was associated with a lower rate of SSI compared to povidone-iodine antisepsis in patients undergoing elective caesarean section and that chlorhexidine-alcohol has a better side effect profile. However, these differences were not statistically significant. RSUM PRPARATION antiseptique, pour prvenir l'infection du site opratoire en cas de csarienne : Un Essai randomis control Objectif: L'objectif de cet essai contrl randomis tait de comparer l'effet de deux prparations de peau antiseptiques diffrents ; chlorhexidine - alcool et la povidone iode sur chirurgicales taux d'infection du site aprs une csarienne et pour dterminer le taux de ractions cutanes la fois la prparation de la peau antiseptique. Mthodes: Un total de 374 patients (188 dans le groupe chlorhexidine - alcool et 186 dans le groupe de povidone iode ) qui ont eu une csarienne sans facteur de risque manifeste pour l'infection du site opratoire ont t recruts . Ils ont subi une csarienne sur la base de la mme technique. Un formulaire a t conu pour recueillir des informations sur les caractristiques sociodmographiques et obsttricales et l'issue nonatale. Les patients ont t contacts des intervalles allant jusqu' trente jours de la livraison, pour valuer les symptmes et signes d'infection du site opratoire et ils ont t traits comme il convient. Rsultats: Cinquante et un (13,6 %) de la population totale de l'tude ont dvelopp une infection du site opratoire . Il n'y avait cependant aucune diffrence statistiquement significative entre le groupe chlorhexidine - alcool et le groupe de l'iode de povidone (12,2% vs 15,1 %, p = 0,26 ) . Trente-sept (66,7 % ) de la SSI tait du type superficiel et l'organisme le plus cultiv tait Staphylococcus aureus . Chlorhexidine - alcool a un profil plus bas dfavorable de raction de la peau que la povidone iode (4,0 % vs 5,4% , p = 0,40 ) . La raction de la peau vu taient le prurit et l'rythme avec aucun tre la vie en danger. Conclusions: Cette tude prospective montre que l'antisepsie la chlorhexidine - alcool a t associe une baisse du taux de SSI par rapport la povidone - iode antisepsie chez les patients subissant une csarienne et qui a un meilleur profil d'effets secondaires chlorhexidine - alcool. Cependant, ces diffrences n'taient pas statistiquement significatives. * A u t e u r c o r r e s p o n d a n t : O l u fe m i A w o r i n d e  HYPERLINK "mailto:aworindeolufemi@yahoo.com" \h aworindeolufemi@yahoo.com ; Nigeria EMERGENCY CAESAREAN SECTION IN USMANU DANFODIO UNIVERSITY TEACHING HOSPITAL SOKOTO, NIGERIA Nasir S, Nwobodo E I, Hassan M, Tunau K, Ahmed Y, Bilal S, Zarro B. Department of Obstetrics and Gynaecology, UsmanuDanfodio University Teaching Hospital Sokoto, Nigeria Correspondence author: Dr.SadiyaNasir,  HYPERLINK "mailto:sadiyanasir@gmail.com" \h sadiy HYPERLINK "mailto:anasir@gmail.com" \h anasir@gmail.com Abstract Background: Caesarean section is a commonly performed procedure both in the developed and developing countries. Its safety has largely been due to improved anaesthetic technique, blood transfusion and antibiotics. The incidence of caesarean section both elective and emergency is on the increase and it varies among countries and within a country and from hospital to hospital. The objective of this study was to determine the rate of emergency caesarean section and its various indications. Methods: It was a 5-year retrospective study carried out in the department of Obstetrics and Gynaecology of UDUTH, Sokoto, from January 2008 to December 2012. It involved the analysis of clinical records of all patients that had emergency caesarean section during the stated period. Results: During the study period there were a total of 15779 deliveries out of which 1943 were by caesarean section both elective and emergency, giving a caesarean section rate of 12.3%. Out of the 1943 women that were delivered by caesarean section 1581(81.2%) had emergency caesarean section. Emergency caesarean section constituted 10.2% of the total deliveries during the study period. The rate was lowest in 2010(7.6%) and highest in 2012(12.5%). The modal 129 age was 30 years with a mean age of 27.8 6.1 years, minimum age of 14 years and maximum of 51 years. Eighty five point eight percent (85.8%) of the women were within 20 39 years age group. The modal parity was 4, with a minimum of 1 and maximum of 14. More than half (61.8%) of the women that had emergency caesarean section were booked in the facility. The most common indications were prolonged labour/CPD (22.9%), malpresentation (14.7%), hypertensive disorders of pregnancy (12.1%) and fetal distress (11.0%). Conclusion: The emergency caesarean section is one the commonest obstetrics procedures performed in the centre and worldwide. The rate obtained from the study is similar to what was obtained in other centers, with prolonged labour/CPD being the commonest indication for emergency caesarean section. CESARIENNE D'URGENCE A L'UNIVERSITE USMANU DANFODIO CHU SOKOTO, NIGERIA RSUM: Contexte: csarienne est une procdure couramment effectues tant dans les pays dvelopps et en dveloppement . Sa scurit a t en grande partie due l'amlioration technique d'anesthsie, la transfusion sanguine et des antibiotiques. L'incidence de la csarienne lective et d'urgence est la hausse et il varie selon les pays et au sein d'un pays et d'un hpital . Objectifs: L'objectif de cette tude tait de dterminer le taux de csarienne d'urgence et de ses diffrentes indications. Matriel et mthodes : Il s'agissait d'une tude rtrospective de 5 ans effectue dans le dpartement d'obsttrique et de gyncologie de UDUTH, Sokoto, de Janvier 2008 Dcembre 2012. Il s'agissait de l'analyse des dossiers cliniques de tous les patients qui ont eu une csarienne d'urgence au cours de la priode indique. Rsultats: Au cours de la priode d'tude il y avait un total de 15 779 livraisons de 1943 qui ont t par csarienne lective et d'urgence, soit un taux de csarienne de 12,3 %. Sur les 1 943 femmes qui ont t livrs par csarienne 1581 (81,2 %) ont eu une csarienne d'urgence. Csarienne d'urgence constitu 10,2% des livraisons totales au cours de la priode d'tude. Le taux tait le plus faible en 2010 (7,6% ) et le plus lev en 2012 ( 12,5% ) . L'ge modal tait de 30 ans avec un ge moyen de 27,8 6,1 annes, l'ge minimum de 14 ans et maximale de 51 ans . Quatre-vingt cinq virgule huit pour cent (85,8 % ) des femmes taient dans 20 39 ans Group d'ge . La parit modal tait de 4, avec un minimum de 1 et un maximum de 14. Plus de la moiti (61,8 % ) des femmes qui ont eu une csarienne d'urgence ont t comptabiliss dans l'tablissement. Les indications les plus frquentes ont t prolonges travail / DPC (22,9% ) , prsentation anormale ( 14,7% ) , les troubles hypertensifs de la grossesse (12,1% ) et la souffrance ftale (11,0 % ) . Conclusion : La csarienne d'urgence est une des procdures les plus courantes en obsttrique poss dans le centre et dans le monde entier. Le taux obtenu partir de l'tude est similaire ce qui a t obtenu dans d'autres centres, avec un travail prolong / DPC tant la plus frquente indication de csarienne d'urgence . DECISION-TO-INCISION-TIME (DTIT) IN DOING EMERGENCY CAESAREAN SECTION IN KOMFO ANOKYE TEACHING HOSPITAL, KUMASI, GHANA R E Larsen-Reindorf, A T Odoi, H S Opare-Addo, and Martin Adjuik Department of Obstetrics and Gynecology, Kwame Nkrumah University of Science and Technology (KNUST)/KOMFO ANOKYE TEACHINGHOSPITAL and INDEPTH Network, Ghana. Correspondence: R E Larsen-Reindorf. E-mail:  HYPERLINK "mailto:larsdorf@yahoo.com" \h larsdorf@yahoo.com Abstract Background: The objective of the study was to find the decision-to-incision time (DTIT) in doing emergency caesarean section in the obstetric service of KATH and any existing point(s) of delay. Methods: The design was an observational time-motion study. Women undergoing emergency caesarean section (CS) over a six-week period were eligible for the study.The study detailed the activities that occurred between the time of decision to do caesarean section and skin incision times, taking note of the events in-between and their times. The data was analyzed using Epi Info and statistical significance determined. Results: A total of 307 emergency cesarean sections were performed during the study period. Only 11.1% of these cases were done within 30 minutes. The mean DTIT varied from 41 minutes for retained second twin to 139 minutes for breech presentation. The median time from decision to incision for all emergency caesarean sections was 78 minutes. The main contributing factors were found to be lack of operating space which resulted in prepared cases waiting in the labour ward for their turn, delay in acquiring intravenous fluids, antibiotics and other drugs from the pharmacy, and inadequate numbers of key personnel. Beyond 75 minutes, there was a trend towards poor Apgar scores though this was not statistically significant. Conclusion: Only one in nine emergency cesarean sections was done within 30 minutes in KATH. The mean and median times in doing emergency caesarean section are long. Re- organization of the obstetric unit and additional resources are required to decrease the decision-to-incision time (DTIT) in doing caesarean section. KEY WORDS: Decision-to-incision-time (DTIT), Decision-to- delivery-time (DTDT), Emergency caesarean section. Objectif: L'objectif de l'tude tait de trouver le temps de dcision l'incision (DTIT) faire une csarienne d'urgence dans le service d'obsttrique de KATH et tout point (s) existant de retard . Mthode: La conception tait une tude des temps et mouvements d'observation. Les femmes ayant une csarienne d'urgence (CS ) sur une priode de six semaines taient admissibles l'tude . L'tude dtaille des activits qui ont eu lieu entre le moment de la dcision de faire une csarienne fois la section et de la peau incision , en prenant note des vnements entre et leur temps. Les donnes ont t analyses l'aide d'Epi Info et la signification statistique dtermine. Rsultats: Un total de 307 csariennes d'urgence ont t effectues au cours de la priode d'tude. Seulement 11,1% de ces cas ont t effectues dans les 30 minutes. Le DTIT moyenne varie de 41 minutes pour la deuxime jumeau conserv 139 minutes pour la prsentation du sige. La dure mdiane de la dcision l'incision pour tous les csariennes d'urgence tait de 78 minutes. Les principaux 130 facteurs ont t jugs manque d'espace d'exploitation qui a entran des cas prpars en attente dans la salle de travail pour leur tour , retard dans l'acquisition des fluides intraveineux , des antibiotiques et d'autres mdicaments de la pharmacie , et un nombre insuffisant de personnel cl . Au-del de 75 minutes, il y avait une tendance des scores d'Apgar pauvres si ce n'tait pas statistiquement significative. Conclusion : Seul un neuf csariennes d'urgence a t fait dans les 30 minutes dans KATH. La moyenne et la dure mdiane de faire une csarienne d'urgence sont longues. Re - organisation de l'unit d'obsttrique et des ressources supplmentaires sont ncessaires pour diminuer le temps (DTIT) dcision incision en faire une csarienne. MOTS CLS : Dcision - - incision - temps (DTIT), dcision la livraison temps (DTDT), la csarienne d'urgence . CAPACITY-BUILDING IN OBSTETRICS AND NEONATAL CARE IN FCT, ABUJA Ameh A C1, Ola Okike, Chilaka V N3, van den Broek N1 Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine Pembroke Place Liverpool L3 5QA, United Kingdom Nyanya General Hospital Abuja Nigeria Royal Derby Hospital, Uttoxeter Road Derby DE22 3NE, United Kingdom Correspondence author: Dr Ola Okike Abstract Background: The MNH unit LSTM and RCOG London-Nigeria Liaison group (RCOG-NLG) secured a 2 year grant from Johnson and Johnson USA to build the capacity of maternity care providers in emergency obstetric and newborn care in FCT Abuja. The programme was to compliment FCT department of health and Human services free ANC, delivery and post-natal care that was followed by additional staff recruitment to cope with the increased patient load. The programme was implemented from April 2011 to March 2012. A 3 day interactive, multidisciplinary, competency based LSTM-RCOG Life Saving Skills- Emergency Obstetric & Newborn Care (LSS- EONC) was delivered by volunteer LSTM and RCOG-NLG members. To ensure sustainability, Master trainers are also trained and 2 sets of training equipment was left behind in designated institutions to facilitate continuous medical education and complement pre-service training. Master trainers were trained on course organization and leadership and hospitals were also provided with essential equipment, which they lacked to perform emergency obstetric and newborn care after the training. Methods: 310 FCT Health Management Board staff from 11 general hospitals, 1 teaching hospital and 1 school of midwifery were trained over 5 back to back courses. Trained staffs were followed-up at 3 and 6 months post-training at their health institutions. Key indicators were set to track progress of the programme and evaluate its effectiveness. Key indicators were number of training courses, number of health care providers trained (proportion of HCP trained from maternity wards), number of master trainers trained, proportion of master trainers in first course, proportion of master trainers in last course, proportion of trained health care providers with at least 70% positive reaction to training package, improvement in overall mean score in pre and post training knowledge and skills test and self reported level of confidence to perform EmONC. Results: 35 Master trainers were trained, 60% of who participated in further training alongside RCOG-NLG members, there were 25% of Nigeria based trainers in the first course and 80% on the last course, 93% of the trainees reacted positively to the training package, there was a statistically significant increase in both knowledge and skills immediately post training with a mean increase of 0.61 and 3.70 respectively. Self reported confidence in performing EmOC (96 health care providers from 8 health care facilities) was 46% at 3months (medical doctors 73.3%, midwives 19.4%) and 56.6% at 6 months (medical doctors 66.7%, midwives 45.7%). Regular CME programmes using LSTM competency based training materials were instituted in 2 of 3 designated training centres by the end of the programme. Lack of key EOC training equipment was the predominant reason for not performing EmONC signal functions. Hand held vacuum extractors and patella harmers were provided to compliment the impact of the training under the programme. Conclusion: LSTM coordinated and implemented a capacity building programme involving volunteer Nigerian Obstetricians in the United Kingdom, to compliment local policies to improve availability of quality maternity care. Regular stakeholder involvement, monitoring and evaluation throughout the programme ensured optimal impact and sustainability of the programme. Short interactive multidisciplinary, competency based in-service training in emergency obstetric and newborn care was acceptable to maternity care providers and resulted in improved knowledge, skills and confidence to provide EmONC. A DOUBLE-BLIND RANDOMIZED TRIAL ON COMPARISON OF PROPHYLACTIC INTRAMUSCULAR ERGOMETRINE AND OXYTOCIN FOR PARTURIENTS IN THE THIRD STAGE GEORGE UCHENNA ELEJE, aCHUKWUEMEKA OKWUDILI EZEAMA, bNKIRU NWAMAKA EZEAMA, aANTHONY OSITA IGWEGBE, aJOSEPH IFEANYICHUKWU IKECHEBELU, aJOSEPH ODIRICHUKWU UGBOAJA, cIFEANYICHUKWU UZOMA EZEBIALU, dAHIZECHUKWU CHIGOZIEM EKE. aDepartment of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital,, Nnewi, Anambra, State, Nigeria bDepartment of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria cDepartment of Obstetrics and Gynaecology, Anambra State University Teaching Hospital, Amaku, Awka, Nigeria.d Department of Obstetrics and Gynecology, Michigan State University/ Sparrow Hospital, Lansing, MI 48912, Michigan, USA. Correspondence: DR ELEJE GEORGE UCHENNA; DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, Nnamdi Azikiwe University Teaching Hospital, Nnewi, PMB 5025, NNEWI, ANAMBRA STATE, NIGERIA Phone= +2348068117444; E Mail=  HYPERLINK "mailto:georgel21@yahoo.com" \h georgel21@yahoo.com Clinical trial registry: Pan African Clinical Trial Registry (www.pactr.org): 201105000292708. Abstract Background: Because of hazards of postpartum haemorrhage, WHO guidelines recommend oxytocin as first choice oxytocics and reverting to ergometrine if oxytocin is unavailable in the third stage of labour. Previous studies on active management of third stage of labour have focused on intravenous administration of these oxytocics. Further studies assessing the intramuscular route are necessary. The objective is to determine the efficacy and adverse effects of 131 intramuscular ergometrine in comparison with intramuscular oxytocin in preventing postpartum haemorrhage during 3rd stage of labour. Methods: Women with singleton pregnancies of at least 28 weeks gestation and had vaginal delivery in Nnamdi Azikiwe University Teaching Hospital Nnewi, south-east Nigeria were included. Oxytocin (10 iu) or ergometrine (0.5 mg) were administered intramuscularly in double-blinded pattern as soon as delivery of the baby. Analysis was by intention-to-treat. Results: A considerable drop in mean total blood loss (301.8109.2 mls vs 287.1 84.4 mls, P = 0.011) and packed cell volume (30.71.7% vs 31.62.0%; Z=0.00; P=0.008) was observed in parturients that received intramuscular ergometrine at the postpartum period. Rates of therapeutic oxytocics, blood transfusion, retained placenta, and manual removal of placenta were significantly high in oxytocin group. No significant differences between groups were observed in terms of adverse effects, with exception of diastolic hypertension, which was more common in ergometrine group (OR=0.00; 95%CI= 0.000.75; P=0.007). Conclusions: Intramuscular ergometrine is superior to intramuscular oxytocin in averting postpartum haemorrhage during 3rd stage of labour in Nigeria. There are no significant risks of adverse effects except diastolic hypertension. THE IMPORTANCE OF INDUSTRY COMPLIANCE IN SUPPORTING THE MEDICAL PROFESSION Alban Briard. HealthCare Compliance Officer, Johnson & Johnson Abstract The healthcare world can be a high-risk and challenging environment that demands a procative compliance approach. Healthcare is turning into an industry focused on Compliance and Regulation. We all want to the right thing: Act with honesty and integrity in business and personal dealings. Recently, a growing number of laws, industry and cooperate guidelines have been introduced, governing how health care compliance should interact with Health Care Professionals. The intent of Health Care Compliance is to ensure the focus of our interactions with Health Care Professional remains on the genuine benefits our product brings to patients. The scope of Health Care Compliance encompasses a wide range of business practices and interaction including: consulting services, hospitality, charitable contributions and educational and research grants. Acting within the Health Care Compliance guidelines and polices will protect the Health Care Professional, healthcare companies, employees and ultimately the patient. The WASC Conference is a perfect opportunity to introduce, to share compliance topics with the Health Care Professionals but also be able to answer questions. L'IMPORTANCE DE LA CONFORMITE DE L'INDUSTRIE A L'APPUI DE LA PROFESSION MEDICALE. Le monde de la sant peut tre un environnement haut risque et un dfi qui exige une approche de conformit procative. Soins de sant est en train de devenir une industrie axe sur le respect et le rglement. Nous voulons tous la bonne chose : agir avec honntet et intgrit dans les affaires et les relations personnelles. Rcemment, un nombre croissant de lois, de l'industrie et de cooprer lignes directrices ont t mises en place, qui rgit la manire dont le respect de soins de sant doit interagir avec les professionnels de soins de sant . Le but de la conformit des soins de sant est d'assurer la mise au point de nos interactions avec les professionnels de la sant reste sur les avantages rels de notre produit apporte aux patients . Le champ d'application de la conformit des soins de sant englobe un large ventail de pratiques commerciales et de l'interaction , y compris : services de conseil , l'hospitalit, les dons de bienfaisance et des bourses d'tudes et de recherche . Agissant dans les lignes directrices et les politiques de conformit de soins de sant permettra de protger le professionnel de la sant , les entreprises de soins de sant , l e s e m p l o y s e t , f i n a l e m e n t , l e p a t i e n t . La Confrence WASC est une occasion parfaite de prsenter, de partager des sujets de conformit avec les professionnels de la sant , mais aussi tre en mesure de rpondre aux questions. WEST AFRICA SURGICAL ACADEMY (WACA) PROFESSIONAL EDUCATION CO-OPERATION PROJECT Stephen Murray Ethicon, Johnson & Johnson Correspondence:  HYPERLINK "mailto:Smurray@its.jnj.com" \h Smurra HYPERLINK "mailto:y@its.jnj.com" \h y@its.jnj.com Abstract Background: Johnson & Johnson has long maintained a goal education healthcare professionals on the safe and efficacious use of product and providing trusted, specialty focused educational activities that maintain, develop or increase the knowledge, skills and performance of Healthcare Professionals (HCPs) in order to improve patients outcomes.The West African College of Surgeons has a strong commitment to surgical education, as detailed in its constitution; include the organization of postgraduate, coordination of education and research, cooperation national and international bodies, and the preparation and publication of journals. Methods: The West African College of Surgical Academy (WASA) represents a co-operation agreement between J&J and WACS to jointly establish a modern surgical training programme at Centres of Excellence across the region in order to enhance the surgical region skills of HCPs. END-POINTS: This will set the standard for, lead and shape the way professionals development programs for HCPs are carried out in the region, according the latest worldwide standard. DOUBLE MARKING OF ESSAYS: DOES INTER-RATER CORRELATION SUPPORT THE PRACTICE? 1Larsen-Reindorf R E, 2Otupiri E, Danso K A, 1Turpin CA, 1Odoi AT. 1Department of Obstetrics and Gynaecology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 2Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana CORRESPONDENCE: R E Larsen-Reindorf, Department of Obstetrics and Gynaecology, School of Medical Sciences, KNUST. Email:  HYPERLINK "mailto:larsdorf@yahoo.com" \h larsdorf@yahoo.com Abstract Background: Objectivity in essay assessment by a single assessor has sometimes been questioned. The Department of Obstetrics and Gynecology of the School of Medical Sciences (SMS) introduced double marking of essay questions in 2007. After 3 years, an assessment was undertaken. The objective was to assess the level of inter-rater correlation for the essays assessed. 132 Methods: A conference marking was done after developing a marking schedule. The seven questions were randomly shared to faculty members who were in groups of 4 or 5. The batch of scripts allocated to each group was further shared. Each assessor recorded his score on a sheet provided and not on the candidate's script. After marking the scripts allocated, the scripts were swapped with another assessor for second independent assessment. At the end, the two assessors collated their results. Results: The collated results were entered into STATA 11.0 statistical package and inter-rater correlation, mean and 95% confidence interval determined. In fourteen of the sixteen pairings (87.5%), the inter-rater correlation was between 0.53 and 0.82, indicating moderate to high inter-rater correlation among the assessors. In six out of the sixteen pairings (37.5%), one assessor significantly scored students higher than the other.In this high-stake examination, inter-rater assessment was moderately correlated in 75% of the time and highly correlated or weakly correlated 12.5%. Conclusion: Double marking of essays was moderately correlated in this study and recommended. The agreed marking scheme may have had an effect on the results. KEY WORDS: Double-assessment, Essay, Inter-rater Correlation DOUBLE MARQUAGE D'ESSAIS : NE INTEREVALUATEURS CORRELATION SOUTENIR LA PRATIQUE? RSUM Objectif: objectivit dans l'valuation de l'essai par un seul valuateur a parfois t remise en question. Le Dpartement d'obsttrique et de gyncologie de la Facult des sciences mdicales (SMS) a prsent double marquage de questions dveloppement en 2007. Aprs 3 ans, une valuation a t effectue. L'objectif tait d'valuer le niveau de corrlation inter-valuateur pour les essais valus. Mthodes: Un marquage confrence a t faite aprs l'laboration d'un programme de marquage. Les sept questions ont t partags au hasard aux membres du corps professoral qui taient en groupes de 4 ou 5 . Le lot de scripts affects chaque groupe a t encore partag . Chaque valuateur a enregistr son score sur une feuille fournie et pas sur le scnario du candidat. Aprs avoir marqu les scripts affects, les scripts ont t changs avec un autre valuateur pour la deuxime valuation indpendante. A la fin, les deux assesseurs rassembls leurs rsultats. Rsultats: Les rsultats rassembls ont t entrs dans STATA 11.0 paquet statistique et inter-valuateur corrlation, moyenne et intervalle de confiance 95 % dtermins. Dans quatorze des seize paires (87,5%), la corrlation entre les valuateurs tait entre 0,53 et 0,82, indiquant modre forte corrlation inter-valuateur parmi les assesseurs. Dans six des seize paires (37,5%), un valuateur a reu beaucoup d'tudiants plus lev que l'autre. Dans cet examen de haute participation, l'valuation inter-valuateur a t modrment corrle 75 % du temps et fortement corrle ou faiblement corrle 12,5%. Conclusion: Double marquage d'essais a t modrment corrl dans cette tude et a recommand. Le systme de marquage accord peut avoir eu un effet sur ?les rsultats. Mots cls: double - valuation, dissertation, l'Inter -rater corrlation THE BURDEN OF ORTHOPAEDIC PRACTICE IN THE WEST AFRICAN SUB-REGION Peace I. Amaraegbulam Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria CORRESPONDENCE:  HYPERLINK "mailto:peacify12@gmail.com" \h peacify12@gmail.com Abstract Background: The burden of musculo-skeletal disease in low and middle-income countries, including Nigeria, is large, growing and neglected. The wide range of musculoskeletal diseases including trauma, infections, congenital anomalies and degenerative diseases are not adequately emphasized, and the knowledge not versatile, even among health workers.The aim of this study is to assess the burden of orthopaedic surgery in West Africa, with the view to making recommendations on adequate care. Methods: Literature search on the topic, personal interviews to health workers and patients, direct observation of the hospitals involved in orthopaedic care. Results: Nigeria has about 500 orthopaedic surgeons, Burkina Faso, Sierra Leone 4, and Ghana about 20 and Liberia 2. These surgeons practice mainly in the cities leaving the rural areas inadequately covered. The rural dwellers use the traditional caregivers more often, and most times present late to the orthopaedic surgeons with complications. There is a dearth of epidemiological studies on these conditions in the centers. Conclusion: There is a high prevalence of musculoskeletal diseases in West Africa. The number of orthopaedic surgeons who should attend to these is few, with most of them practicing in the cities. Mid-level manpower, including traditional bonesetters should be trained to bridge the gap, and health education provided by the surgeons to the populace in order to increase awareness and appropriate health seeking behavior. LA CHARGE DE LA PRATIQUE ORTHOPEDIQUE DANS LA SOUS-REGION OUEST AFRICAINE Introduction: Le fardeau des maladies musculo -squelettiques dans les pays revenu faible et intermdiaire, dont le Nigeria, est grande , de plus en plus et nglig . Le large ventail de maladies musculo-squelettiques, y compris les traumatismes, les infections , les anomalies congnitales et les maladies dgnratives ne sont pas suffisamment soulign , et la connaissance ne polyvalent , mme parmi les travailleurs de la sant . Le but de cette tude est d'valuer la charge de la chirurgie orthopdique en Afrique de l'Ouest, en vue de faire des r e c o m m a n d a t i o n s s u r l e s s o i n s a d q u a t s . Mthodes: Recherche documentaire sur le sujet , des entrevues personnelles pour les travailleurs et les patients sant , l'observation directe des hpitaux impliqus dans les soins orthopdiques. Rsultats: le Nigeriacompteenviron500chirurgiensorthopdistes, le Burkina Faso, la Sierra Leone 4, etle Ghanaetle Libriaenviron 20 2. Thses orthopdistes pratique principalement dans les villes qui quittent les rgions rurales insuffisamment couverts. Les habitants des zones rurales utilisent les dispensateurs de soins traditionnels plus souvent, et la plupart du temps prsentent tard pour les chirurgiens orthopdiques avec complications. Il ya un manque d'tudes pidmiologiques sur ces conditions dans les centres. Discussion et conclusion: Il ya une forte prvalence des maladies musculo-squelettiques en Afrique de l'Ouest. Le nombre de chirurgiens orthopdistes qui devrait participer ceux-ci est peu , aveclaplupartd'entreeuxexerantdanslesvilles.Lamain-d'uvre mi-niveau,ycomprissttersosseusestraditionnelsdevraittreform pour combler l'cart, et l'ducation de la sant fournie par les orthopdistes la population afin d'accrotre la sensibilisation et le comportementderecherchedesoinsappropris. 133 AN INNOVATIVE ADVANCED TRAUMA TRAINING PROGRAM R Davenport, E Cole, J Manson, K Brohi, S Brundage. Barts and The London School of Medicine and Dentistry, London, United Kingdom CORRESPONDENCE:S. I. Brundage, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Blizard Institute, 4 Newark Street, London E1 2AT, United Kingdom. Email:  HYPERLINK "mailto:s.brundage@qmul.ac.uk" \h s.brundage@qmul.ac.uk Background: Traumadeathanddisabilitycastahightoll. Roughly 6 million people die annually secondary to injury. Sub-Saharan Africa has extremely high injury-mortality rates; 119/100,000 versus 48/100,000 for Europe. Injury-related deaths are concentrated in males ages 15-29 (>1/3 of deaths). Despite this burden, surgery is the Neglected Stepchild of Global Health receiving limited educational attention. We hypothesized demandexistsforinnovativepostgraduatetraumatraining. Methods: Beginning 2011, Barts and The London School of Medicine offered an International Masters in Trauma Sciences (MSc). The MSc is delivered as innovative distance-learning targeting multidisciplinary healthcare professionals and designed to support participants from developing countries. We evaluated students enrolling in the MSc and the appeal of a specialized Military& Austerecomponent. Results: Three total cohorts; C1, C2 & C3 have enrolled. Nineteen students in C1, 21 in C2, and 57 in C3. Enrollment rates for Military & Austere were 53%, 10% and 28%. International students comprised 43% of all 3 Cohorts. Students primarily registered from the UK followed by Australia, Ireland, Canada, USA, Singapore, Nigeria, Kenya, Thailand, Pakistan, Malaysia, Poland, Slovakia, Brunei, Netherlands, Greece, Switzerland, Sweden and India. Of the first Graduating Class-12/2013; 57% were awarded Distinction. Knowledge regarding the MSc came primarilyvia Trauma.org(34%) andword-of-mouth(24%). Conclusions: The need for advanced international trauma education exists as reflected by high injury-related mortality and morbidity rates and is accompanied by demand. The overall goal for the Trauma MSc is to create a connected community dedicatedtoreducinginjury-relatedmortalityandmorbidity. OSTEOARTICULAR INFECTIONS OF CHILD: TREICHVILLE (ABIDJAN) TEACHING HOSPITAL'S EXPERIENCE Moulot M O, Anon A G, Yebouet E, Kouame A, Bankole S R. Background: The osteoarticular infection is a frequent and grave disease of the child. It is a medico-surgical emergency with prognosis for survival, which is always improving, but functional prognostic is strongly correlated to early diagnostic and appropriate treatment. The aim of the study was to report our experience of osteoarticular infections of child at Treichville Teaching Hospital. Methods: Retrospective study from January 1st, 2007 to January 31st, 2011 (5 years) on 242 children from 0 to 15years old in Treichville Teaching Hospital. The epidemiological, clinical, paraclinic, therapeuticandoutcomevariableswerestudied. Results: The mean age of the patients was 5.67 years old with extremes of 05 days and 15 years old. The male was most with a sex ratio of 1.69. The average deadline of consultation was 37.6 days. The notions of fever and pain are frequently evoked in 93 % of the cases. The tumefaction was found at 88,8 % of the patients. Infectious osteoarthritis of hip (42.7%) and femur osteomyelitis (32.8%) were the most found localizations. The sedimentation rate and CRP were raised in respectively 94.3% and 58.1% of the cases. The most met bacterium was staphylococcus aureus (34%). The standard radiography was normal in 38,4 %. The protocol ceftriaxone and gentamicin was applied in 89.4% of the cases. The outcome was favorable to 74% of the patients. CONCLUSION: Although the vital prognosis is always improving because of the coming of bearable and effective antibiotic, the functional prognostic remains the challenge in the treatment of the osteoarticular infections. This depends on an early diagnosis with the aim of administering an effective antibiotic treatment, to avoid functional sequelae, which could be very crippling in the adulthood. KEY WORDS: Osteomyelitis; infectious osteoarthritis; septic arthritis INFECTIONS OSTEO-ARTICULAIRES DE L'ENFANT NOTRE EXPERIENCE AU CHU DE TREICHVILLE Moulot M O, Anon A G, Yebouet E, Guemaleu P, Kouame A, Bankole S R. INTRODUCTION: L'infection ostoarticulaire est une maladie frquente et grave de l'enfant. C'est une urgence mdico- chirurgicale dont le pronostic vital est en constante amlioration mais avec un pronostic fonctionnel fortement corrl un diagnostic prcoce et une prise en charge adapte.But: Rapporter notre exprience des infections ostoarticulaires de l'enfant au CHU de Treichville. MTHODE: Etude rtrospective tendue du 01 janvier 2007 au 31 janvier 2011 (05 ans) sur 242 enfants de 0 15 ans au CHU de Treichville. Ont t tudies les variables pidmiologiques, cliniques, paracliniques, thrapeutiques et volutives. RSULTATS: L'ge moyen des patients tait de 5,67 ans avec des extrmes de 05 jours et 15 ans. Il existait une prdominance masculine avec un sex-ratio de 1,69. Le dlai moyen de consultation tait de 37,6 jours. Les notions de fivre et de douleur sont voques constamment dans 93% des cas. La tumfaction a t retrouve chez 88,8% des patients. L'ostoarthrite de la hanche (42,7%) et l'ostomylite du fmur (32,8%) taient les localisations les plus retrouves. La vitesse de sdimentation et la C ractive protine taient leves dans respectivement 94,3% et 58,1% des cas. Le germe le plus en cause tait le staphylocoque aurus (34%). La radiographie standard tait normale dans 38,4%. Le protocole ceftriaxone gentamycine tait appliqu dans 89,4% des cas. L'volution fut favorablechez 74% despatients. CONCLUSION: Bien que le pronostic vital soit en constante amlioration du fait de l'avnement d'antibiotique tolrable et efficacelepronosticfonctionnelrestelechallengedanslapriseen charge des infections ostoarticulaires. Car celui-ci dpends d'un diagnostic prcoce dans le but d'administrer une antibiothrapie efficace afin d'viter des squelles fonctionnelles qui pourraient tretrshandicapantesl'geadulte. MOTS CLS: Ostomylite ; Osto-arthrite ; Arthrite septique CHILDHOOD TRAUMATIC INJURY: A POPULATION BASED STUDY OF ROAD TRAFFIC ACCIDENTS AMONG ALMAJIRAI IN ZARIA 1Makama J G, 2Dahiru T,2Aliyu A A. Institution:1 Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria 2 Department of Community Medicine Ahmadu Bello University Zaria, Nigeria  HYPERLINK "mailto:jgmakama@gmail.com" \h Correspondence:jgmak HYPERLINK "mailto:ama@gmail.com" \h ama@gmail.com Background: Trauma is a leading cause of morbidity and mortality worldwide. Childhood is a period known to have increased physical and exciting activities. Poor judgment of children to dangerous situations, leads to increased chances of injury. Almajiri is a term that describes a child who leaves his home in search of Islamic religious education. These children observe several trips in the Nigerian roads, which are harsh, cruel, insensitive and user-unfriendly traffic environment. Therefore, these groups of children constitute a high risk group to trauma in this environment. 134 Methods: A stratified random sampling was used to select the Almajiri schools. Taken each school as a cluster, the study used an in-depth interview of key informants (Almajiris) that were present in each school selected for investigation. RESULTS: The respondents comprised of 417 (100%) males only. Male children of age group, 3-15years, were more involved in trauma. Three hundred and sixteen (75.8%) admitted having involved in one type of road traffic accident or the other as at the time of running the Almajiri program while 101(24.2%) were not involved in RTA. The basic understanding of road regulations and road signs was limited. The commonest type of RTA was paedestrian occurring in most busy areas like market, motor parks and at rush hours. Commonest body region involved was the extremities (35.3%). Most injuries were attended by a traditional healer with poor outcome. CONCLUSION: Almajirai is a high-risk group to RTA; hence, road traffic accident was a significant cause of injury among them in Zaria. KEY WORDS: Almajiri, Injury, Accident, Road Traffic RSUM Contexte:Le traumatisme est une cause majeure de morbidit et de mortalit dans le monde . L'enfance est une priode connue pour avoir augment les activits physiques et passionnants . Mauvais jugement des enfants des situations dangereuses, conduit une augmentation des chances de blessures . " Almajiri " est un terme qui dcrit un enfant qui quitte sa maison la recherche de l'enseignement religieux islamique. Ces enfants observent plusieurs voyages dans les routes nigrianes, qui sont dures environnement, cruel , insensible et peu convivial trafic . Par consquent, ces groupes d'enfants constituent un groupe haut risque " pour traumatisme dans cet environnement. Mthodologie: Un chantillon alatoire stratifi a t utilis pour slectionner les coles almajiri. Pris chaque cole comme un ensemble , l'tude a utilis une interview en profondeur des informateurs cls ( Almajiris ) qui taient prsents dans chaque cole slectionne pour l'enqute. Rsultats: Les rpondants composs de 417 ( 100 % ) chez les mles seulement . Les garons du groupe d'ge , 3 - quinze annes , taient plus impliqus dans les traumatismes . Trois cent seize ( 75,8 % ) ont admis avoir particip un type d' accident de la circulation routire ou l'autre au moment de l'excution du programme tout en almajiri 101 ( 24,2% ) n'ont pas particip RTA . La comprhension de base de la rglementation de la route et la signalisation routire a t limite . Le type le plus courant de la RTA tait paedestrian survenant dans la plupart des zones trs frquentes comme le march , les parcs automobiles et aux heures de pointe . Frquente rgion du corps atteinte tait extrmits (35,3%) . La plupart des blessures ont t suivis par ungurisseurtraditionnel unmauvaispronostic. Conclusion: Almajirai est un groupe haut risque de RTA , d'o , d'unaccident dela route a t une cause importante deblessures chezeuxdans Zaria . Mots cls: Almajiri, blessures , accidents , la circulation routire EXPERIENCE WITH CLOSED INTERLOCKING NAILING OF THE TIBIA SHAFT USING AN EXTERNAL JIG WITHOUT AN IMAGE INTENSIFIER. Amupitan I, Onche I I, Taiwo F O Department of orthopedics and trauma, Jos University Teaching Hospital, Jos, Plateau State, Nigeria  HYPERLINK "mailto:Idumagbodi@yahoo.com" \h CORRESPONDENCE: Idumagbodi@yahoo.com Background: The tibia is the most commonly fractured bone in the body, and the recommended form of treatment is closed locked nailing on account of its numerous advantages such as minimal disruption of the fracture hematoma.The aim of the study was to determine the outcome of tibia shaft fractures treated by closed interlocking nails in a resource constrained setting. Methods: This is a prospective study in which all tibia shaft fractures treated with closed interlocking nail was reviewed. The fractures within 5cm of both joints of tibia and those in whom the fracture was sitewas opened where excluded. Results: A total of 13 fractures met the criteria, 7 males and 6 females with a male female ratio of 1.16:1, with an age range of 19-60year mean 38.5years. The duration of injury to the time of surgery ranged between 1 day and 14 weeks mean of 10.15days with 12 of the patients operated upon within 2 weeks of injury. Reaming of the tibia was not done in 12 of the patients and was only done in the patient that was operated 14 weeks after the injury because she had an undisplaced non- united fracture. A size 10mm nail was used in 4 patients (30.77%), size 9mm nail in 7 patients (53.85%) and size 8 in 2 patients (15.38%). 6 of the patients commenced weight bearing at 8 weeks, 4 patients at 8 weeks and 1 by 12 weeks all fractures heard showed both clinical and radiologic evidence of healing by 12 weeks post operation. The final functional result (modified Ketenjian's criteria) was excellent in 10 patients good in 2 patients and fair in 1 of the patients CONCLUSION: The use of an image intensifier in closed nailing of the tibia is still the hallmark in management. However in the developing world where such is still not widely available for patient care, they will still benefit from a closed nailing with the use of an external jig in fresh tibia shaft undisplaced fractures. Rsum introduction Le tibia est l'os le plus souvent fractur dans le corps , et la forme de traitement recommande est ferm clouage verrouill en raison de ses nombreux avantages tels que la perturbation minimale de l'hmatome fracture . L'objectif de l'tude tait de dterminer l'issue de fracture de la diaphyse du tibia traites par des clous de verrouillage ferms dans un cadre l imit des ressources . Matriel et mthodes Il s'agit d'une tude prospective dans laquelle toutes les fractures de la diaphyse du tibia traits par clou de verrouillage ferme ont t examins. Les fractures au sein de 5cm de deux articulations du tibia et ceux dans lesquels la fracture tait site a t ouvert o exclus. rsultats Un total de 13 fractures rpondait aux critres, 7 hommes et 6 femmes avec un ratio de 1,16:1 femme homme , avec une tranche d'ge de 38,5 annes moyennes de 19 60 annes . La dure de dommage la fois de la chirurgie varie entre 1 jour et 14 semaines moyennes de 10,15 jours avec 12 des patients oprs aprs un dlai de 2 semaines de blessure. Alsage du tibia n'a pas t fait dans 12 des patients et n'a t fait dans le patient qui a t opr 14 semaines aprs la blessure parce qu'elle avait une fracture sans dplacement non unie . Un clou taille de 10mm a t utilis chez 4 patients (30,77 %) , la taille des ongles 9mm chez 7 patients ( 53,85 %) et de la taille 8 2 patients ( 15,38 %) . 6 des patients a commenc roulement de poids 8 semaines , 4 patients 8 semaines et 1 par 12 semaines toutes les fractures entendu montr la fois la preuve clinique et radiologique de la gurison aprs 12 semaines d'exploitation de poste . Le rsultat fonctionnel final (le critre de ketenjian modifi ) tait excellente chez 10 patients bonnes chez 2 patients et quitables dans 1 des patients conclusion L'utilisation d'un amplificateur de brillance au clouage ferme du tibia est encore la marque de la mairie dans la gestion , mais dans le monde en dveloppement o ce n'est pas encore largement disponibles pour les soins aux patients , ils bnficient toujours d'un clouage ferm avec l'utilisation d'un externe gabarit dans l'arbre de tibia frais fractures non . 135 A NEW METHOD FOR SURGICAL RISK STRATIFICATION BASED ON PRE-OPERATIVE RISK FACTORS IN PAEDIATRIC SPINAL DEFORMITY SURGERY. Oheneba Boachie-Adjei, Mitsuru Yagi, Cristina Sacramento- Dominguez, Harry Akoto, Bettye Wright, Irene Wulff, Jennifer Ayamga Background: Corrective spine surgery for complex deformity is technically demanding and carries a substantial risk. The purpose of this study is to review the postoperative complications in pediatric patients undergoing spine surgery and to establish a pre-operative classification that stratifies surgical risk and case difficulty. Methods: 145 consecutive paediatric spine deformity patients, with various etiologies, who underwent instrumented spinal fusion, were reviewed. A classification was established based on the curve magnitude, etiology, ASA grade, number of levels fused, the pre-op neurologic status, BMI and type of osteotomies. Multiple and Logistic regression analysis (MRA and LRA) were applied to indicate risk factor(S) for complications. We hypothesized that higher the risk score levels will be associated with high complication rates. Results: 5 patients were classified Level 1, 19 were level 2, 25 were level 3, 58 were level 4 and 39 in level 5. Intra-operative neuromonitoring change was observed in 46 cases. Major complication was seen in 45 cases and consisted of implant related (n=13), deep wound infection (n=8), neuro deficit (n=7), death (n=2), and others (n=9). Multiple regression analysis indicated the significant correlation between the risk score (FOCOS level) and %EBL/TBV, time of surgery, and complication ratio. No independent risk factor for complications was observed. Conclusion: The newly established surgical risk stratification based on patient specific clinical and radiographic factors reliably predicts perioperative outcomes and can guide surgeons in their preoperative planning and surgical management of severe spine deformity in order to achieve optimal results. INCIDENCE AND THE RISK FACTORS FOR MAJOR SURGICAL COMPLICATIONS IN PATIENTS WITH COMPLEX SPINE DEFORMITY- A REPORT FROM THE SCOLIOSIS RESEARCH SOCIETY GLOBAL OUTREACH SITE (SRS-GOP) IN GHANA, WEST AFRICA. Oheneba Boachie-Adjei, Mitsuru Yagi, Cristina Sacramento- Dominguez, Harry Akoto, Bettye Wright, Irene Wulff, Jennifer Ayamga Background: Surgical treatment for complex spine deformities is challenging. A multidisciplinary approach is often required in managing these patients peri-operatively and the incidence and risk factors for major peri-operative complications in regions with limited resources (West Africa) are unknown. Methods: A retrospective analysis of a prospectively collected single-center database of 427 consecutive pediatric and adult patients with complex spinal deformities due to various etiologies who underwent instrumented spine surgery was performed. Radiographic and demographic data were reviewed at pre-op and immediate post-op time points. Results: The average age was 15.0 yrs (1-47 yrs). The etiology was idiopathic scoliosis (n=201), congenital deformity (n=103), infectious/TB kyphosis (n=89), neuromuscular scoliosis (n=30), and other (n=4). 86 pts had a three-column osteotomy. Major complications were seen in 85 cases (20%) and consisted of a neurologic deficit [(n=26/6.1%), transient (n=19/4.4%) and permanent (n=7/1.6%)], wound infection (n=17/4%), implant related (n=18/4.3%), progressive deformity (n=13/3%), and death (n=6/1.4%). Univariate predictors of both post op complication and neurologic deficit indicated 3 column osteotomies and curves exceeding 100 degrees as independent risk factors. Conclusion: Post-op complications were seen in 20% of surgically treated patients with complex spine deformities at a SRS GOP site in West Africa. In underserved regions severe untreated spine deformities are often encountered and will challenge the resources of even first world institutions and experienced surgeons. The results of this study should be a guide for surgeons in their pre-operative planning and surgical management of severe spine deformities, especially in global outreach sites where resources are limited. GLOBAL HEALTH AND THE CHALLENGES OF BUILDING AN ORTHOPEDIC CENTRE OF EXCELLENCE IN WEST AFRICA Oheneba Boachie-Adjei, Cristina Sacramento-Dominguez, Harry Akoto, Bettye Wright, Irene Wulff, Jennifer Ayamga Background: Musculoskeletal conditions cause pain, physical disability and loss of personal and economic independence and affect millions of people of all ages in all cultures and in all countries. The prevention and treatment of musculoskeletal conditions and injuries should be among the leading major health concerns in the minds, actions and funding priorities of international health agencies, governments, non- governmental organizations, medical and research communities, funders, media and the general public. Methods: The foundation of orthopedic and complex spine (FOCOS) was established with the Vision to establish a sustainable Infrastructure to deliver state of the Art Orthopedic Care and Education in West Africa and our mission is to provide optimum orthopedic care, to improve the quality of life and expand capacity West Africa. Results: FOCOS has partnered with Philanthropic organizations, Medical device companies, Hospital institutions and benefactors to fund the operations, programs and services at the hospital. To date the 50-bed state of the art orthopedic facility has about 200 employees has had 26,957 outpatient visits and performed 1,100 major orthopedic surgeries with $100million in health care cost savings. The Challenges have included inadequate funding, infrastructure, technical expertise, reliable utilities and the daunting challenges of managing complex and neglected orthopedic diseases. Conclusion: Despite challenges, FOCOS orthopedic hospital in Accra, Ghana is a collaboration of programs and services of international volunteers, local professionals and authorities working together to circumvent the problem with brain drain in West Africa. SURGICAL MANAGEMENT OF SPINAL LESIONS IN NEUROFIBROMATOSIS Harry Akoto, Oheneba Boachie-Adjei, Arthur sackeyfio, Rufia Mahmud Background: Vertebral deformity, scoliosis is a predominant orthopedic manifestation of Neurofibromatosis. Patients may present with debilitating pain and or myelopathy. Failure 136 of management of the deformities is quite common due to the dystrophic nature of the bones. Neurofibromatosis as a cause of spine related disease is well established in the world literature. The documentation in the African medical literature is poor especially cervical spine lesions. The presentation of these patients generally tends to be late in our sub region and the outcomes also tend to be poor. Methods: We present three patients who presented with spinal lesions secondary to neurofibromatosis who were managed very aggressively. These patients were managed over the past 12 months in two institutions. All three patients presented with neurological deficits. All 3 patients were managed with complex spine procedures followed by aggressive physiotherapy. Their ASIA scores before and after surgery was recorded. SRS form 22 was administered. Results: All patients had significant improvement in ASIA score. Both patients who had complete motor deficits were ambulating with assistive devices within 2 months of surgery. One patient who had incomplete motor deficits was ambulating independently within 3 months of surgery. Spine deformity was addressed with complex instrumentation procedures with good restoration of the spine alignment. C o n c l u s i o n : N e u r o l o g i c a l i m p a i r m e n t d u e t o neurofibromatosis has a very good outcome and must be managed with aggressive surgical excision and spine reconstructivesurgery. fond Dformation vertbrale, la scoliose est une manifestation orthopdique prdominante de neurofibromatose. Les patients peuvent prsenter des douleurs et ou mylopathie dbilitante. chec de la gestion des dformations est assez frquent en raison de la nature dystrophique des os . Neurofibromatose comme une cause de la maladie de la colonne vertbrale lies est bien tabli dans la littrature mondiale. La documentation dans la littrature mdicale africaine pauvres lsions de la colonne vertbrale en particulier cervicale . La prsentation de ces patients a gnralement tendance tre en retard dans notre sous-rgion et les rsultats ontgalementtendancetrepauvres. mthodologie Nous prsentons trois patients qui prsentaient des lsions de la colonne vertbrale secondaires la neurofibromatose qui ont t grs de faon trs agressive. Ces patients ont t traits au cours des 12 derniers mois dans deux institutions. Les trois patients prsentaient des dficits neurologiques. Tous les 3 patients ont t traits avec des procdures complexes de la colonne vertbrale, suivie par la physiothrapie agressive. Leurs scores Asie avant et aprs la chirurgie a t enregistr. Forme SRS 22 a t administr. rsultats Tous les patients ont eu une amlioration significative du score ASIA. Les deux patients qui avaient des dficits moteurs complets ont t ambulant avec des appareils fonctionnels dans les 2 mois suivant la chirurgie. Un patient qui avait des dficits moteurs incomplets t Ambulating indpendamment dans les 3 mois suivant la chirurgie. Spine dformation a t traite avec des procdures complexes d'instrumentation ayant un bon rtablissement de l' a l i g n e m e n t d e l a c o l o n n e v e r t b r a l e . Conclusion. Troubles neurologiques dus la neurofibromatose a un trs bon rsultat et doit tre gr par excision chirurgicale agressive et chirurgie reconstructive de la colonne vertbrale dformation. INTRODUCTION: Pygomelia is a rare malformation (1/100000), which defined itself by the presence of one or more supernumerary members in the pelvic region. We report two new cases of which one operated successfully in Abidjan. CASES: The 1st case was characterized by the presence of two additional lower limbs sitting in hypogastric position and a 3rd vestigial pigastric upper limb associated with visceral deformations. The surgical treatment was successfully realized. The clinical examination of the 2nd case objectified the third lower limb at the level of the left buttock with a rudimentary pelvis, a sacrococcygeal tratoma and a genital duplication. The newborn child died during the investigations. CONCLUSION: The nosological limits of pygomelia are still badly specified because it gets closer to duplications of the lower limb and dipygus KEY WORDS: Pygomelia, Dipygus, Caudal duplication LA PYGOMELIE AU CHU DE TREICHVILLE (ABIDJAN) A PROPOS DE DEUX NOUVEAUX CAS. Moulot M., Agbara K S., Yebouet E ,Kouame Agnes, Bankole S R. Introduction: La pygomlie est une malformation rare (1/100000) qui se dfinit par l'implantation d'un ou de plusieurs membres infrieurs dans la rgion pelvienne. Nous rapportons ici deux nouveaux cas dont un opr avec succs Abidjan. CAS: Le 1er cas tait caractris par la prsence de deux membres infrieurs supplmentaires sigeant en position hypogastrique et un 3e membre suprieur vestigial pigastrique associ des malformations viscrales. Le traitement chirurgical a t ralis avec succs. L'examen clinique du 2e cas objectivait un troisime membre infrieur au niveau de la fesse gauche avec un bassin rudimentaire, un tratome sacrococcygien et une duplication gnitale. Le nouveau-n est dcd pendant les investigations. Conclusion: Les limites nosologiques de la pygomlie sont encore mal prcises car elle se rapproche des duplications du membre infrieur et des dipygies. MOTS CLES: Pygomlie, Dipygie, duplication caudale PYGOMELIA AT TREICHVILLE (ABIDJAN) TEACHING HOSPITAL: ABOUT TWO NEW CASES Moulot M, Agbara K S, Yebouet E, Kouame Agnes, Bankole S R 137                                                                 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014  PAGE 104 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014  PAGE 105 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 4 NUMBER 1, JANUARY - MARCH 2014 JOURNAL OF THE WEST 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