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BACKGROUND: The aim is to investigate the clinical and haematologic effects of persistent splenomegaly (PS) and splenectomy in a population of Nigerians with sickle cell anaemia (SCA). MATERIALS AND METHODS: SCA patients attending the Haematology clinic of the OAUTHC, Ile-Ife, were examined physically and haematologically. Patients with PS were compared with age and sex-matched controls without splenomegaly. Foetal haemoglobin (HbF), packed cell volume (PCV), reticulocyte count and the frequency of blood transfusion were noted for both groups. The clinical effects of splenectomy were documented in three patients who underwent the procedure because of symptomatic massive splenomegaly (> or = 10 cm). RESULTS: Seventy-one patients, 40 males and 31 females, aged 16-48 (median, 21) years were studied. Nineteen (26.8%) had PS ranging from 3-22 cm (mean +/- SD = 9.4 +/- 4.4 cm; median = 7 cm). Ten of these had massive splenomegaly (spleen > or = 10 cm) varying from 10-22 cm (mean +/- SD = 12.3 +/- 3.8 cm; median = 12 cm). No significant differences were found between the mean values of HbF, PCV, reticulocyte count, frequencies of pain crisis, transfusion requirement, weights and heights in SCA with PS and age-sex matched controls without PS. Annual transfusion requirement showed a mild negative correlation with splenic size (r = -0.06), which was not statistically significant (p = 0.882). Significant haematologic improvement was confirmed in the 3 patients who underwent elective splenectomy for splenomegaly-induced hypersplenism. CONCLUSIONS: We conclude that massive persistent splenomegaly is a recognised cause of significant morbidity in SCA patients as evident in the patients that underwent splenectomy. However, where it is mild to moderate, PS may not have significant adverse effect on the overall clinical picture of the disorder.

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This is a report of a rare case of bilateral exudative retinal detachment occurring in a young Nigerian male with pyogenic liver abscess. Detailed ocular and clinical examination with biochemical, haematological and microbiological studies of the blood and liver aspirate were done. Ocular and abdominal scan plus surgical drainage of abscess were also done. The main features were febrile illness with hepatomegaly and sudden loss of eyesight. Visual acuity was light perception in both eyes. The cardiovascular and renal systems were normal. Ocular scan showed bilateral bullous retinal detachment while abdominal ultrasound revealed multiple liver abscess cavities. HIV and HBsAg tests were negative. Pyogenic liver abscess should be regarded as possible cause of exudative retinal detachment and has a potential blinding complication.

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The sternum and testis are infrequent localisations for extra pulmonary tuberculosis. The initial response to a co-existing lesion, as this case depicted is, to implicate a malignant process of some sort. A high index of suspicion is needed to overcome this diagnostic riddle. Biopsy of the lesion and bacteriological work-up are essential ingredients of management.

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High morbidity and mortality often attend perforation of duodenal ulcer. Over a 6-year period at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, 22 patients presented with prepyloric or duodenal ulcer perforations--a relatively low yearly rate of about four. Of the 15 patients evaluated, approximately three-quarters were working class young men and eight (53%) had no ulcer history. The high morbidity, and 20% mortality rate, observed were attributable to late presentation and the presence of advanced bacterial peritonitis in 67% of the patients at admission. Imprecise clinical features in those with small perforations led to misdiagnosis in a third of cases. Treatment of perforations in the majority (93%) of patients was by simple closure or truncal vagotomy and pyloroplasty. An increase in patients' awareness of the potentials of optimal operative management should encourage earlier presentation.

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Carcinoma of the male breast is said to be rare. A review of the records at the histopathology laboratory of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, confirms the universal assertion that carcinoma of the male breast is very rare. In over nineteen years of its existence, the laboratory recorded only 10 cases of carcinoma of the male breast. This gives an incidence rate of 1.9% of a total of 513 cases affecting both male and female breasts. All cases were infiltrating ductal carcinoma: there were two cases of papillary, one each of colloid and clear cell carcinoma while the remaining were "not otherwise specified". The age range was 40-80 years with an average of 56.9 years. There was left-sided preponderance with eight cases in the left breast and two cases in the right breast. Six cases had evidence of metastasis either at the time of initial diagnosis or some months after simple mastectomy.

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Closed suprapubic cystostomy using a suprapubic trocar and cannula is a standard surgical procedure for urinary diversion in cases of acute urinary retention. Decannulation is quite easy when the cannula has a side slit which allows easy detachment of the Foley catheter. However when the cannula is without a side slit decannulation becomes problematic. This simple decannulating method is described to overcome this difficulty.

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A case of amoebic recto-vaginal fistula is presented, with a review of literature on this rare complication of intestinal amoebiasis. A temporary defunctioning sigmoid colostomy was necessary. This in combination with oral metronidazole and tetracycline resulted in spontaneous closure of the fistulous tract. Non-traumatic recto-vaginal fistula poses a major diagnostic problem especially in the tropics where many granulomatous infections are endemic and could mimic carcinoma.

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Giant inguino--scrotal hernia is largely a problem of developing countries. A case of an unusually giant inguino-scrotal hernia is reported highlighting the problems encountered in management. Orchidectomy, bowel resection and relaxing epigastric incision were successfully employed in repairing the hernia. Hernias may not be difficult to manage if they ar not neglected. Efforts of health education need intensifying in this direction. We propose thorough peri-operative pulmonary exercises to cut down the post-operative pulmonary morbidity.

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Acute retention of urine is a fairly common emergency problem in medical practice. Suprapubic diversion through a closed or open cystostomy is a standard procedure. In developing countries where there is paucity of skilled manpower and adequate facilities, patients' suffering may be unduly prolonged through delay. This simple cost-effective method was carried out in 15 patients without untoward morbidity. The procedure is particularly useful in rural communities where elaborate facilities are non-existent.

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A review of 47 cases of acute appendicitis in children seen at the Ife University Teaching Hospital over a 7-year period (1980-86) is presented. Over this period the disease was responsible for 0.43% of all paediatric admissions and 18% of all paediatric abdominal emergencies. The clinical features were similar to those in other populations, but in this series there was a tendency towards late presentation with complications which caused significant post-operative morbidity. However, there was only one death.

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For the purpose of defining the distribution of breast diseases in Nigeria, a review of 671 cases seen in Ife over a 10 year period was undertaken. Twenty-six (3.9 per cent) of the patients were males. The frequency of breast diseases in this population was fibro-adenoma, 48 per cent; carcinoma, 21 per cent; breast abscess, 8.6 per cent; fibrocystic disease, 5.5 per cent; sclerosing adenosis, 5.4 per cent and gynaecomastia, 2.7 per cent. The other breast lesions were the same type of disease as documented in white patients. The most striking difference was the relatively high incidence of fibro-adenoma, especially in nulliparous adolescent females, while carcinoma and fibrocystic disease were fewer than expected. Breast carcinoma presented a decade earlier in Nigerian women and was usually advanced at presentation and of aggressive histological type. Of the breast carcinomas, 4.3 per cent were associated with pregnancy.

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