Cardiovascular Findings in Adult Patients with Sickle Cell Anaemia in Steady State seen in Calabar, Nigeria.

BACKGROUND: Sickle cell anaemia (SCA) is associated with significant morbidity and mortality linked to multi-systemic complications. With recent improvements in healthcare globally, it is expected that SCA patients in Nigeria will live longer. The cardiovascular complications may thus become prevalent. SUBJECTS AND METHODS: Fifty-two patients with sickle cell anemia in steady state and 52 controls were recruited. The assessment included history, physical examination, 12-lead resting electrocardiography, 2D, M-Mode and Doppler echocardiography, six-minute walk test and NTerminal pro Brain Natriuretic Peptide (NT-pro BNP) assay. RESULTS: The mean age of the sickle cell patients was 28.87±7.89 years and most were post-secondary or tertiary institutions. They had faster pulse rates (84.69±9.48 vs75.48±10.35 beats/minute, p=0.000), lower blood pressure (Systolic 112.56 ±10.87 mmHg vs 115.42 ± 14.75mmHg; Diastolic 70.79±9.03mmHg vs 71.27±9.23 mmHg) and lower Body Mass Index (21.55±3.51 vs 24.94±4.56kg/m2; p=0.000). Mean left ventricular (LV) internal diameters in systole and diastole were (3.19 ±0.57cm vs 2.81±0.45 cm; p=0.000) and (4.99±0.69cm vs 4.29±0.56 cm; p=0.00) respectively. Left and right ventricular systolic functions were normal. None of the patients with SCA met the criteria for pulmonary hypertension while 88.89% of those screened using Natriuretic peptide were at risk of developing pulmonary hypertension (NT-proBNP levels ≥ 160pg/ml). Functional status assessed by sixminute walk test was normal (373.00 ±60.40m vs 403.83±72.87 m; but significantly lower than in controls (p= 0.021). CONCLUSION: The cardiovascular system is adversely affected in persons with sickle cell anaemia especially as they grow older. Despite the presence of left ventricular remodeling, the patients with SCA in this study maintained good functional status. Regular cardiovascular assessment is advised.

CONTEXTE: La drépanocytose (SCA) est associée à une morbidité et une mortalité importantes liées à des complications multisystémiques. Avec les récentes améliorations des soins de santé dans le monde, on s'attend à ce que les patients atteints d'ACS au Nigeria vivent plus longtemps. Les complications cardiovasculaires pourraient donc devenir prévalentes. SUJETS ET MÉTHODES: Cinquante-deux patients atteints de drépanocytose à l'état d'équilibre et 52 témoins ont été recrutés. L'éva lua tion c om prena it l'histoire, l'exa m en physique, l'électrocardiographie de repos à 12 dérivations, l'échocardiographie 2D, M-Mode et Doppler, un test de marche de six minutes et un test d'apnée du sommeil. le dosage du NTerminal pro Brain Natriuretic Peptide (NT-pro BNP). RÉSULTATS: L'âge moyen des patients drépanocytaires était de 28,87±7,89 ans et la plupart étaient issus d'établissements post-secondaires ou tertiaires. Ils avaient un pouls plus rapides (84,69±9,48 vs75,48±10,35 battements/minute, p=0,000), une pression artérielle plus basse (Systolique 112,56 ±10,87 mmHg vs 115,42 ± 14,75 mmHg ; diastolique 70,79±9,03 mmHg vs 71,27±9,23 mmHg) et un indice de masse corporelle plus faible (21,55±3,51 vs 24,94±4,56kg/m2 ; p=0,000). Les diamètres internes moyens du ventricule gauche (VG) en systole et en diastole étaient de (3,19 ±0,57 cm vs 2,81±0,45 cm ; p=0,000) et (4,99±0,69 cm vs 4,29±0,56 cm ; p=0,00) respectivement. Les fonctions systoliques des ventricules gauche et droit étaient normales. Aucun des patients atteints d'ACS ne répondait aux critères d'hypertension pulmonaire, tandis que 88,89 % des patients dépistés à l'aide du peptide natriurétique étaient à risque de développer une hypertension pulmonaire(taux de NT-proBNP ≥160pg/ml). L'état fonctionnel évalué par le test de marche de six minutes était normal (373,00 ±60,40 m vs 403,83±72,87 m ; mais significativement plus faible que chez les témoins (p= 0,021). CONCLUSION: Le système cardiovasculaire est affecté de manière négative chez personnes atteintes de drépanocytose, en particulier lorsqu'elles vieillissent. Malgré la présence d'un remodelage ventriculaire gauche, les patients atteints d'ACS dans cette étude ont conservé un bon état fonctionnel. Une évaluation cardiovasculaire régulière est conseillée. MOTS CLÉS: Fonction ventriculaire, Drépanocytaires adultes, État d'équilibre, Hypertension pulmonaire.

Public Awareness of Hepatitis B Virus Infection in Cross River State, Nigeria: A Population-Based Survey.

BACKGROUND: Hepatitis B Virus (HBV) infection is a public health problem that is endemic in Nigeria. Cross River State, a tourist state, located in the coastal area of Nigeria has a relatively high prevalence rate. Insufficient knowledge and negative attitudes are barriers to effective control of infectious diseases. OBJECTIVES: To determine the Knowledge, Attitude and Practice (KAP) of HBV amongst residents of Cross River State, Nigeria. METHODS: This was a cross sectional descriptive study. A total of 1,620 healthy adults from the three senatorial districts in Cross River State participated in the study from March to September, 2015. KAP towards HBV was assessed using a structured pre-tested questionnaire. Categorical variables were described as frequencies and continuous variables as median and interquartile range. In the inferential analysis, Kruskal-Wallis test was used to determine the relationship between socio-demographic variables and median KAP scores. A p value < 0.05 was considered significant. All analyses were performed using Stata 12 statistical package. RESULTS: A total of 1,465 respondents completed the questionnaire correctly giving a response rate of 91%. The M: F ratio was 1:1.8. The median age was 38 years. Majority (61%) was married and 32% had formal education up to the tertiary level. Only 45% knew that HBV causes hepatitis. Knowledge of routes of transmission was >50% for blood transfusion, sexual contact and sharps but < 48% for vertical transmission. Median and interquartile range of knowledge scores for the south, central and northern senatorial districts were 8 (2-14), 13 (5-17) and 14 (6-18) which varied significantly with age (p =0.027). The overall attitude and practice towards persons living with HBV was poor. There was good correlation between KAP scores (p<0.05). CONCLUSION: Knowledge of hepatitis B is low among adults in Cross River State. This correlates with poor attitude and practice towards HBV. There is need to utilize health education strategies to improve awareness among the populace, if Nigeria is to meet the global target of elimination of viral hepatitis by 2030.

Prevalence of hepatitis B, hepatitis C and human immunodeficiency viruses, and evaluation of risk factors for transmission: Report of a population screening in Nigeria.

BACKGROUND: Hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV are common blood-borne infections unevenly distributed across regions in Nigeria. Few population-based prevalence studies have been done in Nigeria. OBJECTIVE: To determine the prevalence of HBV, HCV and HIV and risk factors for infection with these viruses in a Nigerian population. METHODS: Hepatitis B surface antigen, anti-HCV and HIV were assayed in 1 498 healthy adult participants. A structured questionnaire was used to assess risk factors for viral acquisition. Bivariate analysis was used to compare differences in sociodemographic characteristics. Significant risk factors were identified by stepwise logistic regression. A p-value <0.05 was considered significant. RESULTS: The prevalences of HBV, HCV and HIV were 8.8%, 10.0% and 12.9%, respectively, with urban/rural disparity. HBV/HCV positivity was higher among males than females. The reverse was true for HIV. Age was significantly associated with being HBV-, HCV- or HIV-positive. Communal use of a toothbrush was significantly associated with HBV positivity in the final model (odds ratio 2.46, 95% confidence interval 1.45 - 4.18). CONCLUSIONS: The prevalence of HBV, HCV and HIV infection is high in Nigeria, with urban/rural disparity. HCV may be more of a public health concern than HBV in some communities. Population-based studies are required to provide vital data to inform optimal national control strategies.

Prevalence of dysglycemia in Calabar: a cross-sectional observational study among residents of Calabar, Nigeria.

OBJECTIVE: Population data on dysglycemia are scarce in West Africa. This study aimed to determine the pattern of dysglycemia in Calabar city in South East Nigeria. DESIGN: This was a cross-sectional observational study. METHODS: 1134 adults in Calabar were recruited. A multistage sampling method randomly selected 4 out of 22 wards, and 50 households from each ward. All adults within each household were recruited and an oral glucose tolerance test was performed. Dysglycemia was defined as any form of glucose intolerance, including: impaired fasting glucose (blood glucose level 110-125 mg/dL), impaired glucose tolerance (blood glucose level ≥140 mg/dL 2 h after consuming 75 g of glucose), or diabetes mellitus (DM), as defined by fasting glucose level ≥126 mg/dL, or a blood glucose level ≥200 mg/dL, 2 h after a 75 g glucose load. RESULTS: Mean values of fasting plasma glucose were 95 mg/dL (95% CI 92.1 to 97.5) for men and 96 mg/dL (95% CI 93.2 to 98.6) for women. The overall prevalence of dysglycemia was 24%. The prevalence of impaired fasting glucose was 9%, the prevalence of impaired glucose tolerance 20%, and the prevalence of undiagnosed DM 7%. All values were a few percentage points higher for men than women. CONCLUSIONS: The prevalence of undiagnosed DM among residents of Calabar is similar to studies elsewhere in Nigeria but much higher than the previous national prevalence survey, with close to a quarter of the adults having dysglycemia and 7% having undiagnosed DM. This is a serious public health problem requiring a programme of mass education and case identification and management in all health facilities. TRIAL REGISTRATION NUMBER: CRS/MH/CR-HREC/020/Vol.8/43.

Study of electrolyte changes in patients with prolonged labour in ikot ekpene, a rural community in niger delta region of Nigeria.

Background. Prolonged obstructed labour is a major cause of maternal and perinatal morbidity and mortality especially in the developing countries of the world, where the incidence is high. These complications are partly attributed to the metabolic and electrolyte derangements that are often associated with this problem. It is, therefore, important to evaluate the metabolic and electrolyte changes of these patients in a rural community in a developing country. Objective. To compare the electrolyte changes, maternal, and perinatal outcomes in patients with prolonged obstructed labour with that of normal labour in General Hospital Ikot Ekpene, Akwa Ibom State, Nigeria. Patients and Methods. This is a prospective cross-sectional case control study conducted in the Labour Ward of the General Hospital Ikot Ekpene to compare the electrolyte levels and perinatal outcome of 95 pregnant women who had prolonged labour with 105 women who had normal labour within the same period. Main Outcome Measures. Electrolyte changes, ketonuria, maternal complications, and perinatal outcome. Results. The majority of women with prolonged labour (91.6%) had major surgical interventions requiring anaesthesia. Perinatal death occurred in 12.6%, and a major life-threatening maternal complications (including two deaths) occurred in 13.7% of those with prolonged labour compared to 2.9% (with no death) in those with normal labour. Significant abnormal electrolyte changes included hyperkalemia, high urea, and creatinine as well as low bicarbonate levels were recorded. Metabolic abnormality was shown by ketonuria in 91.1% of the patients compared to 1.9% in women with normal labour. Conclusion. Women with prolonged labour in Ikot Ekpene have significant electrolyte and metabolic changes which impact adversely on the maternal and perinatal outcomes of the pregnancy. Effort should be made to correct these electrolyte and metabolic abnormalities during resuscitation of the woman in order to reduce the complications associated with such derangements.

Diverse blood exposures associated with incident HIV infection in Calabar, Nigeria.

Few types of blood exposures have been assessed in relation to incident HIV infection in sub-Saharan Africa, despite evidence that penile-vaginal sex cannot account for the epidemic in the region. To investigate correlates of incident HIV infection in Calabar, Nigeria, we surveyed clients at voluntary HIV counselling and testing centres. Participating clients who tested multiple times were generally similar to those testing only once in terms of demographic characteristics, sexual and blood exposures and HIV prevalence. Blood exposures were common. Serial testers had a 10% annual incidence of HIV infection. Seroconverters and seronegative serial testers were similar on most demographic characteristics and sexual exposures. However, seroconverters were more likely than seronegatives to report blood exposures during the test interval, both for most specific exposures as well as summary measures of blood exposures. In particular, seroconverters were substantially more likely to report one of a set of blood exposures that cannot be explained as a consequence of unprotected vaginal sex or of health care for symptoms of HIV infection (adjusted odds ratio = 6.6, 95% confidence interval = 1.2-38). The study design we used is an inexpensive approach for describing the local epidemiology of HIV transmission and can also serve as the foundation for more definitive investigations that employ contact tracing and sequencing of HIV DNA.

Chronic foot ulcer complicating a traumatic arteriovenous fistula

Background: Chronic foot ulcers could be a complication of traumatic arteriovenous (A-V) fistulation. We report a rare case of chronic foot ulcer and deformity resulting from arteriovenous fistula of the anterior tibial artery. Method: The clinical presentation and the outcome of treatment in a patient treated at the University of Calabar Teaching Hospital (UCTH) Calabar are reported. The relevant literature on this subject matter is briefly reviewed. Result: A case of chronic foot ulcer and oedema secondary to traumatic arteriovenous fistula of the anterior tibial artery was managed by the authors at the University of Calabar Teaching Hospital. The diagnosis was mainly clinical as sophisticated equipment was not readily available and satisfactory healing was achieved by exploration; quadruple ligation; skin grafting and cast application. Conclusion: Prompt diagnosis and treatment of difficult cases should warrant sophisticated equipment to make diagnosis

Anaesthetic challenges in surgical excision of phaeochromocytoma

Background: Phaeochromocytoma is a rare tumour; which is benign but metabolically active; with a potential for malignancy. This tumour of adrenal or extra adrenal origin usually presents as hypertension; which can be sustained or paroxysmal and with lethal complications. Aim: To present an anaesthetic experience during the surgical resection of a phaeochromocytoma. Method: A 26-year old woman with phaeochromocytoma of the right adrenal gland is presented. The tumour was excised under general anaesthesia. The anaesthesia involved the use of continuous infusion of esmolol (an ultra short-acting intravenous cardioselective beta-antagonist) and propofol. The resected tumour was sent for histopathological examination. Results: The tumour was completely excised under general anaesthesia. The haemodynamic changes that occurred during tumour handling were controlled with fentany1;propofol/esmolol infusion. Histopathological findings confirmed phaeochromocytoma. Conclusion: Although; the anaesthetic and surgical management of a phaeochromocytoma could be an uphill task; it is possible in an environment with limit laboratory and intensive care facilities

The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long-term review.

BACKGROUND: A long-term review of metal prosthetic radial head replacement in patients with radial head fractures associated with gross instability of the elbow has been performed. METHOD: Twenty patients were reviewed using a modified Mayo Clinic functional rating index system. The mean follow-up was 12.1 years, with a range from 6 to 29 years. RESULTS: Results were excellent in 12 patients, good in 4 patients, fair in 2 patients, and poor in 2 patients. A metal radial head replacement restored elbow stability when fracture of the radial head occurred in combination with dislocation of the elbow, rupture of the medial collateral ligament, fracture of the proximal ulna, and/or fracture of the coronoid process. CONCLUSION: We conclude that a metal radial head prosthesis has select indications. We advocate its use when the radial head cannot be reconstructed in the setting of a clinically unstable elbow. Results suggest that it functions well on a long-term basis.

Periarticular heterotopic ossification: a complication of arthroscopic anterior cruciate ligament reconstruction using a two-incision technique.

Extra-articular heterotopic bone formation was recognized as a postoperative complication of arthroscopic anterior cruciate ligament reconstructions in four knees around the femoral drill hole. Although laxity of the reconstructed anterior cruciate ligament was not observed in these patients, local pain, swelling, and deformity at the site of heterotopic ossification required surgical intervention. The ectopic bone can be successfully excised with restoration of function. The incidence rate of this complication is less than 1%.

Arthroscopic debridement for the osteoarthritic ankle.

We were able to review 27 out of 32 patients who had arthroscopic debridement for osteoarthritis of the ankle. The patients had symptoms for an average of 4 years before the procedure. The average follow up was 45 months. Following arthroscopic debridement, 17 of the 27 patients showed improvement, although only 2 ankles were restored to normal function. There was a statistically significant improvement in pain, swelling, stiffness, limp, and activity level. Changes in the feeling of instability failed to reach significance. Overall, there were 2 complications of numbness related to the anterolateral portal, but these resolved. Arthroscopic debridement of the ankle can offer relief to approximately two thirds of patients, but it is important to stress to patients that the degree of improvement is limited.

Insulin-like growth factor 1 (IGF-1) receptors, IGF-1, and IGF-2 are expressed in primary human sarcomas.

A variety of bone and soft-tissue sarcoma cell lines have been shown to express receptors for insulin-like growth factor-1 (IGF-1) and to respond mitogenically to IGF-1 in vitro. We have recently demonstrated evidence of IGF dependency in murine MGH-OGS and RIF-1 sarcomas, which express relatively high and intermediate levels of IGF-1 receptors. Overexpression of IGF-1 receptors and/or IGF ligands might, therefore, be a mechanism by which human bone and soft-tissue sarcomas obtain a proliferative advantage over normal adjacent tissues. Therefore, we evaluated 29 human sarcoma specimens for expression of IGF-1 receptor, IGF-1, and IGF-2 by competitive binding and reverse-transcription polymerase chain reaction (RT-PCR) techniques. Twelve of 29 sarcomas examined by RT-PCR and 13 of 25 examined by affinity-binding studies expressed IGF-1 receptor levels equal to or greater than levels determined in the IGF-responsive MCF-7 breast carcinoma cell line. DNA amplification of the IGF-1 receptor gene was not identified in this group of sarcomas that expressed high levels of IGF-1 receptor. Evaluation of IGF ligand expression by RT-PCR revealed that 22 of 28 sarcomas expressed IGF-1 levels comparable to or above those of the RPMI 7666 control line, and 17 of 27 sarcomas expressed significant levels of IGF-2 compared with the NCI H69 control cell line. These results suggest that autocrine/paracrine regulatory mechanisms might be responsible for the growth of some sarcomas.

Metastatic behavior of the RIF-1 murine fibrosarcoma: inhibited by hypophysectomy and partially restored by growth hormone replacement.

BACKGROUND: We recently demonstrated that hypophysectomy profoundly inhibits metastatic behavior in the MGH-OGS murine osteosarcoma model and speculated that this effect is related at least in part to ablation of the growth hormone (GH)-insulin-like growth factor I (IGF-I) axis. PURPOSE: In this study, we determined whether the administration of GH to animals rendered GH and IGF-I deficient by hypophysectomy attenuates the inhibitory effects of hypophysectomy on metastatic behavior. METHODS: Metastatic behavior was assayed by counting visible metastases in lungs 3 weeks after tail vein injection of RIF-I fibrosarcoma cells to control mice (n = 29), hypophysectomized mice (n = 19), and hypophysectomized mice administered 0.05 microgram/g body weight recombinant human GH twice daily (n = 21). RESULTS: Twenty of 21 hypophysectomized mice receiving GH, eight of 19 hypophysectomized mice not receiving GH, and 26 of 29 controls had grossly visible pulmonary metastases 3 weeks after intravenous injection of 5 x 10(5) cells; mean numbers +/- SD of gross metastases were 38.4 +/- 11.3, 6.4 +/- 2.2, and 13.1 +/- 2.8 in the three groups, respectively. The presence (P < .005, chi-square test) and number (P = .0003, Mann-Whitney U test) of metastases were significantly reduced in hypophysectomized hosts compared with control hosts and were significantly higher in hypophysectomized, GH-replaced hosts compared with hypophysectomized hosts (P < .001, chi-square test; P = .011, Mann-Whitney U test), while the difference in presence and extent of metastases between control and hypophysectomized, GH-replaced hosts was not statistically significant. CONCLUSIONS: These data support the hypothesis that the status of the host with respect to GH and/or GH-dependent factors such as IGF-I influences the metastatic behavior of certain neoplasms. IMPLICATIONS: Our results raise the possibility that compounds that reduce GH output or interfere with GH action, such as somatostatin analogues, GH antagonists, IGF antagonists, and GH-releasing hormone antagonists, may suppress metastatic behavior of certain neoplasms.

Wrist and hand ganglion treatment with hyaluronidase injection and fine needle aspiration: a tropical African perspective.

In an attempt to provide an alternative non-invasive treatment to surgical excision of ganglion cysts of the hand, and as part of the departmental audit resulting from the prevailing economic depression, 340 consecutive patients with 349 ganglia were treated in a prospective investigation by intralesional injection of hyaluronidase (up to 150 units in 1 ml) followed by fine needle aspiration (FNA) of the cyst to dryness. Pressure was applied over a piece of gauze and maintained with a crepe bandage for 24 h. Of the 340 patients treated in this way, the vast majority (323 or 95.0%) were considered to be cured on clinical examination at 6-month follow-up; only 17 patients (5.0%) exhibited recurrence during this period and these were successfully treated by re-aspiration. To the knowledge of this author, this is the first report of the use of the enzyme hyaluronidase as an adjunct to FNA in the treatment of ganglion cysts of the hand. The results clearly show that this method of treatment is a safe, fast, well accepted and cost-effective alternative to surgical excision, which is relatively expensive and is known to be associated with certain complications, including hypertrophic scars and cheloids.

Management of long-term postirradiation periclavicular complications.

Four cases of periclavicular postirradiation sarcoma and two cases of clavicular osteoradionecrosis with pathologic fractures are reported. All six cases presented more than 10 years after irradiation for breast cancer (five) or nasopharyngeal carcinoma (one). A review of radiotherapy received showed that they were subjected to unconventional radiation schedules (hypofractionation or high dose per fraction treatment). An approach to diagnosis and management of periclavicular lesions arising long after therapeutic irradiation is presented and the unique problems encountered with periclavicular surgery are discussed.

Tropical Surgical abdominal emergencies blunt splenic rupture in Calabar

A detailed study of splenic rupture in 34 consecutive patients living in souttheastern equatorial rainforest Nigeria was conducted during a 5-years period. The results clearly show that blunt abdominal injury from road traffic accident (RTA) was the cause of rupture in the vast majority of cases. Road traffic accident was due in many cases to collision with a motor bike which is a popular means of transportation in this region. Although the external injury to the abdomen was slight; and in some cases nil; the ensuing trauma to the spleen was extensive. In contrast RTA due to the motor car; seen in 5 of the 34 patients studied; caused much associated injury to the patient. The pattern of splenic rupture seen in this tropical African community is out-standingly in contrast with that of the developed countries of the West where spontaneous rupture of diseased spleen seems to be common

Tropical surgical abdominal emergencies: acute intestinal obstruction.

In a prospective evaluation of acute intestinal obstruction in emergency surgery, 3550 consecutive patients were studied. In the vast majority of patients (75%), obstruction was due to the external hernia, the inguinal hernia being by far the commonest type. However, the ascaris worm in children, volvulus of the sigmoid colon in adults, and intussusception in both children and adults, were significant causes of the disorder, and together accounted for 18% of the patients. Obstruction by the ascaris worm is easy to diagnose (by stool microscopy), and effective treatment (with antihelminthics) is readily available and cheap. A large number (90%) of the volvulus patients required resection for gangrene of the colon, thus arguing a strong case in support of laparotomy and inspection of the colon whenever feasible. A significant (41%) proportion of intussusception cases were adult, and in 33% of this group the lesion was associated with a tumour of the small bowel. The chief reason for death (10%) was late reporting to hospital.

Benign breast tumours in an African population.

A detailed prospective clinical study of 238 women presenting with benign breast swellings in the South Eastern equatorial rainforest of Nigeria clearly shows that 94% of lesions were due to two disorders, fibroadenomas and bacterial infections, and that they affected mostly young women in the peak of their reproductive life. Fibroadenoma which accounted for disease in no less than 69% of the women was multiple in 8%, bilateral in 11%, and was considered giant in size in 5% of the cases; by contrast, fibroadenosis was rare, accounting for swellings in only eight patients. Bacterial infections, chronic pyogenic mastitis and tuberculosis together caused breast swellings in 25% of the women studied. In tropical Africa, multiple chronic discharging sinuses suggest tuberculosis of the breast.

Prospective evaluation of simple suture in the surgical treatment of perforated peptic ulcer.

In a prospective study aimed at evaluating a safe treatment for perforated peptic ulcer in tropical African conditions 205 patients who presented with perforation of a peptic ulcer in South-Eastern Nigeria during the ten year period January 1973 to December 1982 were treated by simple suture. The ulcers were classified at operation from appearance and feel as acute in 155 patients (75.6%), and chronic in the remaining 50 patients (24.4%). Of this number 21 patients (10.2%) died post-operatively. All 21 patients had chronic pyloroduodenal ulcers which were complicated by haemorrhagic in 10 patients (5.0%) and extensive scarring of the duodenum and pyloric stenosis in 9 patients (4.4%). By way of contrast, no patient with acute pyloroduodenal ulcer died and none was known to suffer from recurrent dyspepsia at 6 months to 1 year follow-up. These results clearly show that simple suture is adequate and safe treatment for perforated acute pyloroduodenal ulcer; however, this form of treatment carries an unacceptably high mortality in those patients with perforated chronic pyloroduodenal ulcers. These patients should, where feasible, be treated by definitive ulcer - curative surgery.