Expanding access to surgical care toward universal health coverage: Leveraging sustainable financing strategies for Sub-Saharan Africa.

The National Surgical Obstetric and Anaesthesia Plan is an invaluable country resource with the capacity to promote increased access to safe and affordable surgical and anaesthesia care if implemented. Although cost of implementation is only a fraction of Health Sector Strategic Plan cost in the countries with costed plans, it is important that the funding of the plans is based on sustainable financing strategies. This will ensure appropriate and timely implementation and sustainability of the plan itself. The aim of this review was to discuss and make recommendations on innovative and sustainable strategies for financing national surgical plans in sub-Saharan Africa.

INTESTINAL OBSTRUCTION CAUSED BY APPENDICITIS: A SYSTEMATIC REVIEW.

BACKGROUND: The known complications of appendicitis include perforated appendicitis with generalised peritonitis, appendiceal mass, appendiceal abscess, sepsis, adhesion formation and in a few occasions, small bowel intestinal obstruction. AIM: To review published cases of intestinal obstruction due to appendicitis with a view to better understand the pathophysiology of this complication. METHODOLOGY: A search of the literature in the MEDLINE database, using PubMed and OvidSP, Scopus, Google Scholar and Cochrane Databases with the following MeSH terms: (Appendicitis or appendiceal mass, appendiceal abscess or appendiceal adhesion band) and (intestinal obstruction, intestinal herniation, intestinal strangulation, intestinal knotting and paralytic ileus) was done. Also, these searches were restricted according to the following MeSH limits: (a) January 1, 1950 to July 31, 2016, (b) English articles (c) Human. RESULTS: Overall, 27 articles reported 45 patients with intestinal obstruction due to appendicitis. Of the 30 (66.7%) patients that the gender was indicated, 22 (48.9%) were male while 8 (17.8%) were female. In 38 (84.4%) cases the cause was mechanical obstruction resulting from one or a combination of the following: (a) appendix laid across loops of bowel bound down by adhesions, (b) herniation through a ring or gap formed by the appendix tip being attached to its base, (c) appendix tip attached to the bowel causing a torsion, (d) kinking of the bowel, (e) complex knotting. Pre-operative diagnosis was a major challenge and so, none was approached through incision based on the McBurney's point.The outcome of treatment which was mostly achieved by immediate appendectomy followed by adhesiolysis was sufficient and often gave good results. CONCLUSION: This study has shown that appendicitis is an important cause of intestinal obstruction. Even though pre-operative diagnosis is still a major challenge, clinical evaluation and a high index of suspicion are key to diagnosis.

Drain Site Hernia: A Review of the Incidence and Prevalence.

BACKGROUND: Surgical drains prevent fluid accumulation such as peritoneal fluid, blood, pus or inflammatory exudates. However, complications may occur. The aim of this study is to review the incidence and prevalence of drain site hernia as a complication of surgical drains. MATERIAL AND METHODS: A search of the literature in the MEDLINE database, using PubMed and OvidSP, Scopus, Google Scholar and Cochrane Databases with the following MeSH terms: (Drain or surgical drain or drainage) AND (drain hernia, drain-site hernia, laparoscopic drain-site hernia)was done. Also, these searches done from 14th-31st Dec 2013 were restricted according to the following MeSH limits: (a) January 1, 1980 to December 14, 2013, (b) English articles (c) Human. RESULTS: Overall, 24 articles had 49 patients with drain site hernias. Of this, 7 (14. 3 %) post open surgery while 42 (85.7 %) post laparoscopic surgery. Seven (14.3 %) occurred immediately after the operation/removal of drain, 10 (20.4 %) several days to 2 week, while 32 (65.3 %) several months to years. Commonest organ of herniation was 13 (26.5 %) small bowel, while morbidities, arising from drain site hernias occurred in 17 (34.7 %) with the highest 7 (14.3 %) due to bowel strangulation. Previous reports have quoted the incidence of drain site hernia to be 3.4% (5 of 148), and 0.14% (8 of 5541). Mortality was extremely low (2.0 %). CONCLUSION: Attention is warranted for drain site hernias as a significant complication following placement of surgical drain. Incidence (0.1-3.4 %), though wide range, is quite significant in these patients. Therefore, unwanted surgical drain insertion should be avoided.

Role of vesicostomy in the management of posterior urethral valve in Sub-Saharan Africa.

OBJECTIVE: To review the role of vesicostomy in the management of posterior urethral valve (PUV), in neonates and infants, given the limitations for endoscopic treatment in this setting. METHODS: A review of 35 patients who presented with posterior urethral valve over a 10-year period. Demographic and clinical information were prospectively recorded on a structured pro forma, and the data extracted analysed using SPSS 11.0. RESULTS: The 35 boys were aged 3 days to 10 years (median 3 weeks). Twenty-three (65.7%) had a vesicostomy (age range 3 days-3 years, median 3 weeks). The mode of presentation was poor urinary stream 15 (65.2%), urinary retention 4 (17.4%), and renal failure 6 (26.1%). Main findings were palpable bladder 23 (100%), hydronephrosis 4 (17.4%). Abdominal ultrasound confirmed hydronephrosis and thickened bladder wall, and voiding/expressive cystourethrogram confirmed dilated posterior urethra and vesicoureteric reflux in all 23 patients. Complications following vesicostomy were stoma stenosis 1 (4.3%), bladder mucosal prolapse 1 (4.3%), perivesicostomy abscess 1 (4.3%); there was no mortality. Following vesicostomy, 10 (43.5%) patients had excision of the valves and vesicostomy closure at age 2-8 years (median 4 years). They are well, with normal renal ultrasonographic findings, bladder capacity range 115-280 ml, and normal urea, serum electrolytes, creatinine, at 3 years of follow up. Thirteen (56.5%) are still awaiting valvotomy but have remained well and with normal ultrasonographic renal findings. CONCLUSION: Vesicostomy is a useful temporising mode of urinary diversion in neonates and infants with posterior urethral valve (in the absence of unobstructed upper tracts) when facilities for endoscopic valve ablation are not readily available.

Pattern of paediatric solid cancers seen in radiotherapy and oncology department, Ahmadu Bello University Teaching Hospital, Zaria - Nigeria.

UNLABELLED: Summary AIMS AND OBJECTIVES: To evaluate the Pattern of Paediatric solid cancers seen over 5 years in the Radiotherapy and Oncology Department of Ahmadu Bello University Teaching Hospital, Zaria-Nigeria. MATERIALS AND METHODS: The study involved patients aged 16 years and below diagnosed with solid cancers referred to the Radiotherapy and Oncology Centre for further management. Between January 2006 and December 2010, a total of 136 new patients with paediatric solid cancers were seen and evaluated. Only patients with histological confirmation were included in the study (136 out of 141 patients) irrespective of cancer type, sex, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Information retrieved from patients folder included age, sex, histological type, stage and types of treatments received. Results were presented in tables. RESULTS: A total of 136 patients were evaluated with a mean age of 6.9 years (median of 5 years, age range 1.5 - 16 years). 74 patients (54.4%) were 5 years and below and 98 patients (72%) were 10 years and below. The sex ratio M:F was 1.3:1. At presentation at the Radiotherapy and Oncology centre, only 4 (3%) patients had early stage disease, 100 (73.5%) with locally advanced disease and 32 (23.5%) with metastatic disease. Retinoblastoma 48 (35.3%) was the commonest cancer seen followed by soft tissue sarcoma 20 (14.7%, all rhabdomyosarcoma), lymphomas 15 (11%) (9 Burkitt's and 6 Hodgkin's lymphoma), nephroblastoma 13 (9.6%), bone sarcoma 12 (8.8%) (8 Osteosarcoma and 4 Ewing's sarcoma), nasopharyngeal cancers 8 (5.9%), brain cancer 6 (4.4%), sacrococcygeal tumours 6 (4.4%) and other cancers accounted for 8 (5.9%). 116 (85.3%) patients received chemotherapy, 86 (63.2%) patients were scheduled for radiotherapy but only 21 (15.4%) received local field irradiation due to financial constraints and 43 (31.6%) had definitive surgery. Palliative care with medications was done in 22 (16.2%) patients. Of 48 patients with retinoblastoma, 30 affected left eye, 16 affected right eye and 2 patients were with bilateral retinoblastoma. The mean age for retinoblastoma was 3.8 years (median age of 3 years and mode is 3 years). The mean age for rhabdomyosarcoma was 8.7 yr (median age of 6.5 years). CONCLUSION: Paediatric solid cancers were found to be more common in males than females with more than half being diagnosed in children aged 5 years and below. Retinoblastoma and rhabdomyosarcoma were the most common neoplasms. Most patients presented with locally advanced and metastatic cancers. Geographic variation exists with histological types.

Quality of teaching provided by surgical residents: an evaluation of the perception of medical students.

BACKGROUND: Surgical residents teach and interact with Medical students during surgery clerkship. However, the quality of teaching by surgical resident as perceived by medical students has not been assessed in our setting. The aim of this report is to evaluate the quality of teaching provided by surgical residents as perceived by Medical students METHODS: This is a cross sectional study involving final year 2005-2006 medical students ofAhmadu Bello University Zaria, Nigeria. The characteristics and skills of surgical residents' teaching role as perceived by medical students were determined. The Information was obtained using a structured questionnaire. Data obtained was analyzed using SPSS version 11.0 RESULTS: A total of 120 medical students participated in the study. The age range was 24-36 years (mean 26.88 + 2.19). There were 87 (72.5%) males and 33 (27.5%) females. In assessing the qualities of a teacher among surgical residents, 83 (69%) of the students believed the surgical resident has good teaching skills, 101 (84%) believed they were committed to teaching, 118 (98%) they were available, 109 (91%) had inspirational ability. In assessing the qualities of a surgeon, 116 (97%) believed the surgical resident has enthusiasm for surgery, 106 (88%) empathy for patients, 78 (65%) fund for knowledge. Assessment of the qualities of a supervisor revealed 118 (98%) Got medical students involved, hands on, 78 (65%) set fair expectations, 113 (94%) Gave them feedbacks, 118 (98%) supervised them adequately. In term of the qualities of the person 107 (89%) believed a surgical resident is supportive, 94 (78%) considerate, 115 (96%) friendly, 108 (90%) fun to work with. Overall assessment perceived by medical students revealed Senior Registrar having better qualities of teaching than Registrar. These qualities were rated good and outstanding by majority of the medical students. CONCLUSION: Medical students' perception of teaching provided by surgical residents is encouraging in our setting. This emphasizes the important role of the surgical resident in undergraduate medical training. Thus, the teaching skills of surgical residents should be encouraged and sustained.

Management of anorectal malformation: Changing trend over two decades in Zaria, Nigeria.

BACKGROUND: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. MATERIALS AND METHODS: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. RESULTS: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5%) and 106 (65.8%) emergency operations in groups A and B, respectively. There were 61 (45.5%) and 55 (34.2%) elective operations in groups A and B, respectively. Regarding treatment, in group A, patients requiring colostomy had transverse loop colostomy, while in group B, sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5%), anal transplant 5 (8.2%), sacroabdominoperineal pull through (Stephen's operation) 6 (9.5%) and others 21 (34.4%). In group B, posterior sagittal anorectoplasty (PSARP) 46 (83.7%), anal transplant 1 (1.8%), posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6%) and anal dilatation 6 (10.9%) were done. Early colostomy-related complication rates were similar in the two groups (P > 0.05). The overall late complication rate was 65.5% in group A and 16.4% in group B (P < 0.05). The mortality was 25 (18.6%) in group A compared to 17 (10.6%) in group B (P < 0.05). CONCLUSION: There have been significant changes in the management of anorectal malformations in this centre in the last two decades, resulting in improved outcomes.

Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria

Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5) and 106 (65.8) emergency operations in groups A and B; respectively. There were 61 (45.5) and 55 (34.2) elective operations in groups A and B; respectively. Regarding treatment; in group A; patients requiring colostomy had transverse loop colostomy; while in group B; sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5); anal transplant 5 (8.2); sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5) and others 21 (34.4). In group B; posterior sagittal anorectoplasty (PSARP) 46 (83.7); anal transplant 1 (1.8); posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6) and anal dilatation 6 (10.9) were done. Early colostomy-related complication rates were similar in the two groups (P 0.05). The overall late complication rate was 65.5in group A and 16.4in group B (P 0.05). The mortality was 25 (18.6) in group A compared to 17 (10.6) in group B (P 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades; resulting in improved outcomes

Music in the operating theatre: opinions of staff and patients of a Nigerian teaching hospital.

BACKGROUND: The role of music during surgery has been studied, including its effect on theatre staff, users and patients. However, little attention has been paid to its application especially in our environment. METHODS: It was a prospective study, involving theatre staff, users, and patients. Their opinions on acceptability and the role of music in operating theatre were determined. Information was obtained by questionnaire. RESULTS: There were 162 respondents; age range 25 to 76 years (median age 39). There were 109 (67.2%) males and 53 (32.7%) female. One hundred and forty five (89.5%) respondents agree that music should be played in the operating theatre. One fifty eight, (97.5%) considered low tone of music to be most appropriate in the theatre while 3(1.9%), and 1(0.6%) considered moderate and high tone respectively to be most appropriate. One hundred and sixteen, (71.6%) preferred jazz music while 19(11.7%) reggae, 11(6.8%) African music, 13 (8.0%) others (not specify), 2 (1.2%) classical, and 1(0.6%) Irish folk. The majority of the respondents were aware of the role of music in terms of its anxiolytic effect, reduction of stress and enhancement of performance when familiar music is played. CONCLUSION: Music in the operating theatre has immeasurable effects. It can prevent distraction, minimize annoyance, reduce stress and diminish the anxiety of patients, staff and users.

Does general surgery clerkship make a future career in surgery more appealing to medical students?

BACKGROUND: Medical students' decreasing interest in surgical careers has raised much concern. This report is to ascertain the influence of surgical clerkship on the perceptions of medical students on prospects of a future career interest in surgery. METHODS: A cross sectional study, involving final year medical students. Information concerning their interest in a surgical career, what they thought of surgery before and after general surgery clerkship was obtained. RESULTS: A total of 120 medical students participated in the study. The age range was 24 - 36 years (mean 27+2). There were 87 (72.5%) males and 33(27.5%) females. Ten students (8.0%) were interested in surgery before their last surgery clerkship, 18 (15%) Obstetric and Gynaecology, 92(76.6%) others. Those that developed interest in surgery following the clerkship increased to 33 (27.5%) (P<0.001), 34 (28.3%) Obstetric & Gynecology, while other specialties reduced to 53 (44.2%). One hundred and one (84.2%) (M = 71, F = 30) students believe they had identified a role model or a mentor during the clerkship, either a consultant or a resident. Eighty eight (73.3%) (M = 62, F = 26) student who liked and loved surgery at the end of the clerkship identified surgical mentors during their time. CONCLUSION: General surgical clerkship has influence on future career in surgery among medical students. Focused and effective mentoring by faculty as well as early exposure of students to positive role models should help to reverse negative impressions held by students.

Challenges of managing paediatric abdominal trauma in a Nigerian setting.

BACKGROUND: The management of abdominal trauma (particularly blunt trauma) has undergone tremendous revolution in the last 30 years with significant reduction in morbidity and mortality in developed countries. The aim of this report is to highlight the challenges of managing abdominal trauma in children in Nigeria based on our experience in Zaria, northern Nigeria. METHOD: This is a retrospective review of 82 children managed for abdominal trauma from 1991 2002 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information regarding demographics, mechanism of injury, haemodynamic status at presentation, clinical and radiologic evaluation, management, intraoperative findings and outcome, were extracted from case notes, operation notes and discharge summary notes. RESULTS: Fifty seven (69.5%) children had blunt trauma, mostly from traffic accidents (32, 57%) and falls (20, 36%), and 25 (30.5%) penetrating trauma mainly from falls onto sharp objects (7 of 18 patients) and animal-related injuries (5 of 18 patients). In the management of those with blunt trauma, advanced imaging modalities were usually not available and this resulted in an unnecessary laparotomy rate of 51% (laparotomy considered unnecessary because the patients remained haemodynamically stable after resuscitation and any intraperitoneal bleeding had stopped by the time oflaparotomy and no active operative measure was required to control bleeding). The management of penetrating trauma was more straightforward as this was guided by evidence of peritoneal penetration. Mortality from blunt trauma was 14.5% (8 of 55 patients) from exsanguinations before surgery 2, gastric perforation 3, hepatic laceration 2 and splenic injury one. Mortality from penetrating trauma was 12% (3 of 25 patients) from tetanus, overwhelming infection and haemorrhage respectively. The overall mortality from abdominal injury was 13.8% (11 of 80 patients) and were mostly avoidable if the patients presented early, and received some resuscitation before arrival at our hospital. CONCLUSION: The management of blunt abdominal trauma in children in Nigeria is faced with several challenges, which are mainly absence of an organised trauma system and lack of appropriate facilities. These need to be addressed in order to improve the care of these injuries.

Timing of passage of first meconium and stooling pattern in normal Nigerian newborns.

BACKGROUND: The time of passing meconium and the subsequent stooling pattern is an important marker in the diagnosis of colonic motility problems in newborns, particularly in Hirschsprung's disease (HD). METHOD: A cross-sectional study of the passage of meconium and stooling pattern in 280 normal newborns was undertaken using questionnaires administered to mothers attending a postnatal clinic. RESULTS: There were 143 boys and 137 girls aged 6-49 days (median 19 days); 266 (95%) had been full-term infants, 252 (90%) normal deliveries and 28 (10%) delivered by caesarean section. The birthweight of 25 (9%) had been <2.5 kg. Of 267 infants whose mothers knew the time of first passing meconium, it had been delayed for up to 48 hours in 45 (16.9%) and up to 72 hours in 15 (5.6%), and six (2.2%) passed meconium after 72 hours. Overall, 201 (75.3%) passed meconium within 24 hours of birth, 246 (92.1%) within 48 hours and 261 (97.8%) within 72 hours. Irrespective of the time of passing meconium, 80 (31%) infants continued to pass stools at least once daily, 107 (42%) twice daily and 65 (24%) three or more times daily. Only 11 infants were on artificial milk along with breast milk; the remainder were exclusively breastfed. Mode of delivery, birthweight and artificial milk had no effect on time of passing meconium and the subsequent stooling pattern. CONCLUSION: This study has shown that only 76% of normal infants passed first meconium within 24 hours and, by 3 days of life, a small minority still had not passed meconium. Nearly all normal infants being breastfed should defaecate at least once daily. These findings should be useful in the evaluation of newborns suspected to have HD in this and similar settings.

Echocardiographic findings in children with surgically correctable non-cardiac congenital anomalies.

BACKGROUND: Congenital cardiac anomalies may co-exist with non-cardiac congenital malformations and, for those requiring surgical correction, there can be an anaesthetic risk. AIM: To estimate the burden of congenital heart disease (CHD) in children with surgically correctable non-cardiac congenital malformations. PATIENTS/METHODS: Records of 120 children aged between 1 week and 11 years [mean (SD) 0.6 (1.5) years] undergoing corrective surgery for non-cardiac congenital malformations were examined. Results of clinical cardiac examination and surgical and echocardiographic findings were analysed. RESULTS: Cleft lip or palate was the commonest surgical anomaly (46, 38.3%), followed by ano-rectal malformation (32, 26.7%). Forty-two children (35.0%) had an abnormal echocardiographic scan. A cardiac abnormality was detected clinically and confirmed by echocardiography in ten patients (8.3%), which represents 24% of all the cardiac abnormalities. The commonest cardiac anomalies were atrial septal defect (ASD) (30 children, 25%), followed by ventricular septal defect (VSD) (seven children, 5.8%). The frequency of ASD was highest in children with a cleft lip or palate (14/46, 30.4%). CONCLUSIONS: Over one-third of patients undergoing surgical correction of congenital malformations have co-existing CHD. Echocardiography is important for pre-surgical evaluation. No association between type of CHD and specific non-cardiac congenital malformations was found.

Role of astrovirus in intussusception in Nigerian infants.

Intussusception (IS) is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. Viral infections, mostly adenovirus, enteroviruses, human herpesvirus and Epstein-Barr virus are reported in 20-50% of childhood cases of IS. Between January and July 2004, six stool specimens collected from infants 0- to 8-months old diagnosed and admitted for IS were investigated for the presence of rotavirus, astrovirus and adenovirus antigens. Astrovirus antigen was detected in three of the six stool specimens by enzyme immune assay (EIA) and confirmed in two specimens by reverse transcription-polymerase chain reaction (RT-PCR). Rotavirus, non-enteric adenovirus and astrovirus were detected by EIA, as mixed infections in a single specimen. The rotavirus strain revealed a SGI+II, mixed G1G2G8P[6] genotype and had no visible electrophoretic profile. A larger study is needed to determine the extent of involvement of astroviruses in IS in infants and the virus should be included in studies investigating the aetiology of IS.

Transanal protrusion of intussusception in infants is associated with high morbidity and mortality.

BACKGROUND: Although anal protrusion of intussusception in infants is well recognised, it is rarely reported and confusion with rectal prolapse often results in delayed diagnosis and treatment. This report highlights the problems of diagnosis and the morbidity and mortality associated with this condition. METHOD: A retrospective case series of five infants presenting to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria with anal protrusion of intussusception over a period of 5 years. During that time, 17 children were treated for intussusception at ABUTH. RESULTS: The anal protrusion rate of intussusception was 29%. The five infants were three girls and two boys aged 4-18 months (median 8). The duration of symptoms was between 6 and 28 days (median 21). The features were mainly protruding anal mass, diarrhoea and vomiting. Abdominal pain and passage of bloody stools occurred late. There was delay in referral and treatment owing to misdiagnosis as rectal prolapse. The intussusception was ileocolic in four patients and in one the type could not be ascertained before death. Two patients had perforation of the involved intestine and another had gangrene of the intestine, necessitating intestinal resection. In one patient, there was no bowel compromise and only open reduction was necessary. Two patients died from overwhelming infection, one before surgery and another after surgery. CONCLUSION: The risk of morbidity and mortality in anal protruding intussusception is high. As early features might not be typical of intussusception, a high index of suspicion is necessary to avoid confusion with rectal prolapse so as not to delay diagnosis and treatment.

Surgical drains: what the resident needs to know.

BACKGROUND: Drains continue to be an important aspect of the management of surgical patients. Its use has been contentious. However, when indicated, it is important that drainage should be practiced with prudence. METHODS: Publications from both local and international journals through Medline, pub med and Google search (June-August, 2007) were reviewed. RESULTS: Drains remove content of body organs, secretion of body cavities and tissue fluids such as blood, serum, lymph and other body fluid that accumulate in wound bed after surgical procedures. Therefore, reduction of pressure to surgical site as well as adjacent organs, nerves and blood vessels, enhances wound perfusion and wound healing. Reduction of pain is also achieved. However, drains are now known not to be innocuous especially when they are poorly selected, wrongly used and left in situ for too long. Essentially, passive and active drains are the most practically useful type. CONCLUSION: Understanding the benefits and applications of surgical drains and tissue responses to constituent material is not only relevant to a practicing surgeon but would help to reduce the abuse of surgical drains.

Pseudoprune belly syndrome; its' associations and management challenge in a developing country: a case report.

BACKGROUND: Pseudo prune belly syndrome is an incomplete expression of the triad syndrome. Its incidence is poorly documented worldwide. We are not aware of any documented cases in Nigeria in recent times. Diagnosis is clinical; however, ultrasound scan plays key role in the overall assessment of the patient. METHOD: It is a report of an 8 day old boy who had pseudo prune belly syndrome with associated micro colon and rectal atresia managed at the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, in October, 2005. CONCLUSION: Management of this patient was challenging due to lack of frozen section facility parenteral nutrition and finance. Awareness of the associated conditions and how to manage them is emphasized for good outcome.

Computer Knowledge amongst Clinical year Medical Students in a Resource Poor Setting

Objective: To study the computer knowledge and desires of clinical year medical students at one of the oldest and largest medical schools in Nigeria. Design: A survey using validated structured questionnaires. Setting: Medical school of Ahmadu Bello University; Zaria; Nigeria.Subjects: Two hundred and thirty seven clinical year (4th; 5th and 6th years) medical students. Outcome measures: Computer knowledge; mode of acquiring computer knowledge; regular access to computer; desire for inclusion of computer training in curriculum. Results: One hundred twenty (50.6) students had knowledge of computer technology and it use. Of these; 108 (90) had no regularaccess to a computer and none owned a computer; only 32 (26.7) were sufficiently familiar with computer tools to perform advanced tasks; but 72 (60) were comfortable with word processing. Seventy two of the 120 students acquired their computer knowledge through self-learning efforts while 45 (37.5) attended short periods of formal training. Overall; 45.7of males and 64.5of females had computer knowledge. The main reason for lack of computer knowledge was lack of time and lack of access to a computer. Eighty percent of all students would like computer education to be included in medical school curriculum. Conclusion: Knowledge and use of computers amongst clinical year medical students in this setting is low. It is important that computer education be taught to the students to enhance their ability to use electronic information and communicate more effectively using computer resources

Surgical Drains: What the Resident Needs to Know

Background: Drains continue to be an important aspect of the management of surgical patients. Its use has been contentious. However; when indicated; it is important that drainage should be practiced with prudence. Methods: Publications from both local and international journals through Medline; pub med and Google search (June-August; 2007) were reviewed. Results: Drains remove content of body organs; secretion of body cavities and tissue fluids such as blood; serum; lymph and other body fluid that accumulate in wound bed after surgical procedures. Therefore; reduction of pressure to surgical site as well as adjacent organs; nerves and blood vessels; enhances wound perfusion and wound healing. Reduction of pain is also achieved. However; drains are now known not to be innocuous especially when they are poorly selected; wrongly used and left in situ for too long. Essentially; passive and active drains are the most practically useful type.Conclusion: Understanding the benefits and applications of surgical drains and tissue responses to constituent material is not only relevant to a practicing surgeon but would help to reduce the abuse of surgical drains

Surgical Drains: What the Resident Needs To Know

Background: Drains continue to be an important aspect of the management of surgical patients. Its use has been contentious. However; when indicated; it is important that drainage should be practiced with prudence. Methods: Publications from both local and international journals through Medline; pub med and Google search (June-August; 2007) were reviewed. Results: Drains remove content of body organs; secretion of body cavities and tissue fluids such as blood; serum; lymph and other body fluid that accumulate in wound bed after surgical procedures. Therefore; reduction of pressure to surgical site as well as adjacent organs; nerves and blood vessels; enhances wound perfusion and wound healing. Reduction of pain is also achieved. However; drains are now known not to be innocuous especially when they are poorly selected; wrongly used and left in situ for too long. Essentially; passive and active drains are the most practically useful type.Conclusion: Understanding the benefits and applications of surgical drains and tissue responses to constituent material is not only relevant to a practicing surgeon but would help to reduce the abuse of surgical drains