Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

The vomiting reflex evolved as a defensive one centered mainly on the gastrointestinal tract. It is also a symptom of many diseases of the gastrointestinal tract and other systems. Its occurrence with nausea in the postoperative period poses a challenge to surgeons and anaesthetists alike. To avoid the unwanted effects of postoperative nausea and vomiting in patients, pre, intra and postoperative factors that contribute to its occurrence should be prevented or treated. Antiemetics, acupuncture and other drugs are used to prevent and treat postoperative nausea and vomiting. Those that manage patients in the postoperative period should endeavour to make postoperative nausea and vomiting as unacceptable as postoperative pain.

Key words: Postoperative, Nausea, Vomiting, Narcotics, Antiemetics

Neurosurgery Unit, Department of Surgery, Usmanu Danfodio University Teaching Hospital, Sokoto, Nigeria

For an effective practical management of head injury, a clear knowledge of the various causes and mechanism of head injury is essential. The concept of the brain in a rigid cranial cavity makes the pathophysiological mechanism of head trauma unique. Most problems occur due to poor handling of patients at the site of trauma or lack of adequate resuscitation before radiological investigation at the emergency department. With adequate management of intracranial pressure and nursing of unconscious patient, most patients can be managed without neurosurgical consultation. Timely referral and surgical intervention can prevent the catastrophic effects of rapidly expanding intracranial haematoma. This paper discusses practical management head injury management and highlighted some pit falls in management.

Key words: Head injury, management, pitfalls

Department of Medicine, Ahmadu Bello University, Zaria, Nigeria.

The study was an open labeled non-comparative study to evaluate the safety and efficacy of Combivir^TM (3TC 150mg/ZDV 300mg) tablets and Agenerase^TM (Amprenavir) (APV 150mg) capsules in the treatment of HIV positive patients with CD4 cell counts of 100 - 300/mm³. Twenty-one patients aged 25 to 63 years who met the admission criteria were recruited into the study. There were ten males and eleven females. Informed consent was obtained from each patient. Baseline CD-4 Lymphocyte count, Full Blood Count and Complete Serum Biochemistry were done for each patient. Each patient received Combivir^TM 450mg b.d. and Agenerase^TM 1200mg b.d. dispensed 4-weekly over a twenty-four week period. 80.5 % of the patients showed an immunological response to therapy with the mean CD4 cell count of the patients rising from 184 cells/mm³ at the beginning of the study to 545 cells/mm³ at the end (p=0.000). The patients also experienced weight gain and improvement in quality of life. Few side effects were reported and these were mainly gastrointestinal. One patient withdrew from the study on account of abdominal pain and failure to notice a clinical response after eight weeks of therapy. One patient who was a known diabetic had a worsening of his blood sugar control. This responded to Insulin therapy. No other significant laboratory abnormalities were noted. It was concluded that the combination of Combivir^TM (3TC 150mg/ZDV 300mg) tablets and Agenerase^TM (Amprenavir) (APV 150mg) capsules was safe and efficacious in the treatment of HIV positive patients with CD4 cell counts of 100 - 300/mm³.

Key Words: Agenerase^TM, Combivir^TM, Anti-retroviral therapy

Department of Medicine, Ahmadu Bello University Hospital, Zaria, Nigeria

This is a 10 year retrospective review of patients managed at the Ahmadu Bello Teaching hospital, Zaria, Nigeria for myasthenia gravis. Only 4 patients were identified from the hospital’s records. Myasthenia gravis appears uncommon in this environment. Reasons for the apparent rarity of this condition and other autoimmune diseases in the environment are discussed.

Key words: Myasthenia gravis, northern Nigeria, autoimmunity

Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Three cases of infranuclear facial nerve palsy associated with infection by the human immunodeficiency virus type 1 are reported. All were previously asymptomatic and had no other symptom suggestive of HIV infection. Two patients had typical Bell’s palsy while one had a facial diplegia. CD4 cell counts were above 100 cells/mm³ in all cases. A review of the literature confirmed that peripheral facial nerve palsy could occur at any stage of HIV infection and in various clinical contexts. It is suggested that adult patients presenting with peripheral facial paralysis should be counseled, and screened for HIV Infection.

Key words: Peripheral facial paralysis, HIV

Department of Medicine, Ahmadu Bello University Hospital Zaria, Nigeria

Atrial septal aneurysm usually complicates a patent foramen ovale and atrial septal defect. An 80-year-old female presented with two weeks symptoms of chest infection. Examination revealed consolidation in the right lower zone posteriorly in the chest, a third heart sound (S3) and hepatomegaly. Sputum microscopy and culture were unremarkable and the chest radiograph revealed a mild cardiomegaly (CTR = 0.53) and consolidation in the right lower zone. Echocardiography revealed an ejection fraction of 36.5% and fractional shortening of 17.6%, displacement of the middle portion of the inter-atrial septum into the left and right atria (the defect was 1.6cm) and the displacement was more than 10 mm. Atrial septal aneurysm is known to be a risk factor for cardiac failure and cerebrovascular events in middle aged and elderly individuals.

Key words: Atrial septal aneurysm

This is a report of a 45-year-old man who had intussusception for 2 years but presented only after he developed chronic anaemia and cardiac decompensation.

Key words: Intussusception, chronic, anaemia

Department of Paediatrics, Ahmadu Bello University Teaching, Hospital, Zaria, Nigeria

An otherwise healthy 33 days old girl, displaying features of the Nail-Patella syndrome is reported. This rare autosomal dominant disorder is characterised by nail and bone abnormalities, with nail hypoplasia or dysplasia and absent or hypoplastic patella as essential features for the diagnosis. The patient had bilateral absent palpable patella with hypoplasia of the fingernails. Our patient did not have the typical iliac horns and there was no evidence of renal involvement.

Key words: Nail-Patella syndrome

Department of Medicine St. Agnes Hospital, Baltimore, MD 21229, United States of America

A 72-year-old female with a history of hypertension and hyperlipidemia presented with alternating numbness, tingling sensations and weakness of both upper extremities with left shoulder pain. Each episode of these symptoms lasted about thirty minutes and reoccurred three times on either side of her upper limbs at about 2 hourly intervals. She had no associated headache, blurry vision, slurred speech or diplopia. Six years prior to presentation, she underwent a successful repair of an unruptured abdominal aortic aneurysm. Significant findings include; blood pressure of 177/74-mm Hg and a radial pulse rate of 78 beats per minute, blood urea nitrogen (BUN) of 21, creatinine, and abnormal lipid profile. Head CT was negative. Chest x-ray showed calcification and tortuosity of the thoracic aorta. A trans-thoracic echo was negative for vegetation while trans-esophageal echocardiogram (TEE) showed a tortuous thoracic aorta and an ulcerative plaque with an overlying four-cm irregular mobile thrombus in the aortic arch and several small mobile clots. The patient treated with aspirin, heparin and placed on warfarin for one year at target I.N.R of 2.0-3.0. She was symptom free at one-year follow-up.

Key words: Aortic arch, atheroma, fleeting monoparesis

Departments of Surgery, Ahmadu Bello University Teaching Hospital, Zaria and *Nnamdi Azikwe University Teaching Hospital, Nnewi, Nigeria

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