Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in Nigeria. The government should take measures to combat transplantation tourism and the problem of national and international trafficking in human tissues and organs, ethics commission and National Transplant registry should be established in order to monitor and regulate the programme in the country.

Background and Objective: There are various postulated possible causes of surgically symptomatic prolapsed intervertebral discs in the lumbar and sacral regions. They may be acting singularly or collectively. Yet, these factors, which could vary in different environments, have not been satisfactorily confirmed. The intention of this study is to share the experience of the author in the occurrence, possible causative factors, and treatment of surgically symptomatic prolapsed lumbar and sacral intervertebral discs in females, and to compare this experience in Switzerland, Nigeria, and Jamaica using surgery records for a period of over 39 years. Materials and Methods: Records of these cases were examined and analyzed with the intent of comparing the frequency of occurrence and possible causative factors of this lesion in some countries. Results: There were 60 locations in 51 patients in Basel (Caucasian population only), 4 locations in 1 patient in Imo and Ebonyi States (African population only), and none in Jamaica (mixed population). The patients' ages ranged from 19 to 71 years in Switzerland, and the only patient in Nigeria was 49 years old. Conclusion: The study revealed that surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs in females occurred more in Basel, Switzerland, than in Imo and Ebonyi States of Nigeria and none occurred in Jamaica, West Indies. Racial differences, certain sporting/recreational activities, smoking, and type of profession could have contributed to the development of this disease.

Background: A disarticulation resection is a variant of mandibular segmental resection in which the condylar articulation is sacrificed. Indication varies from primary condylar lesions to jaw conditions involving the condyle. Aim: This retrospective analysis was carried out to highlight the pattern of disarticulation resections carried out in our centre over a five-year period. Materials and Methods: Cases of mandibular resection were identified from the operation book. The medical records of patients who had disarticulation resection were then retrieved and analyzed for demography, indications for disarticulations, methods of reconstruction and complications. Results: A total of 20 cases of disarticulation with complete records were obtained, this constituted 24.7% of total mandibular resections in the department. There were 9 males and 11 females with a male: female ratio of 1:1.2. The age ranged between 13 and 59 years with a mean of 30.4 years (std. 12.0). Sixteen patients received autogenous bone graft; two were stabilized using Steinman's pins and two with reconstruction plates. One bone graft and one reconstruction plate were removed because of infection and exteriorization respectively. Condyle was not replaced in any case. Outcomes were satisfactory but jaw deviation on opening was a common complaint in all cases. Conclusion : Condylar disarticulation accounts for a considerably high percentage of mandibular resection in our centre. Non vascularized immediate bone grafting without actual joint reconstruction was common. No disarticulation was carried out for traumatic reasons.

Aim/Objective: To determine the pattern of morbidity and outcome among patients referred to the Pediatric Surgery Unit of the Lagos University Teaching Hospital (LUTH) following circumcision. Materials and Methods: Retrospective descriptive study of all patients with complications of circumcision who were managed in LUTH between 2008 and 2010. Results: There were 36 patients. The age range was between 2 days and 9 years (median-3 months). Fifteen cases (42.9%) were due to urethro-cutaneous fistula while there were six cases (16.7%) of postcircumcision bleeding. There were four cases (11.1%) each of partial penile amputation and buried penis. There were also cases of meatal stenosis, penile implantation cyst and glanulo-preputial skin bridge. With respect to the treatment offered, eleven (30.6%) patients had urethroplasty for the urethro-cutaneous fistulae while seven (19.4%) patients had penile refashioning for the buried penis and penile amputation. Appropriate surgical treatments were performed for the other complications. Conclusion: Urethrocutaneous fistula and penile amputation are the commonest complications of circumcision for which referral is made to LUTH. Treatment outcome was satisfactory. Health education and legislation to ensure procedure is performed by qualified medical and paramedical staff may reduce the morbidity.

Background: The underlying pathological conditions in cardio-thoracic patients, anesthetic and operative interventions often lead to complex physiological interactions that necessitate ICU care. Our objectives were to determine the intensive care unit (ICU) utilization by cardio-thoracic patients in our centre, highlight the common indications for admission; and evaluate the interventions provided in the ICU and the factors that determined outcome. Materials and Methods: The intensive care unit (ICU) records of University College Hospital, Ibadan for a period of 2 years (October 2007 to September 2009) were reviewed. Data of cardio-thoracic patients were extracted and used for analysis. Information obtained included the patient demographics, indications for admission, interventions offered in the ICU and the outcome. Results: A total of 1, 207 patients were managed in the ICU and 206 cardio-thoracic procedures were carried out during the study period. However, only 96 patients were admitted into the ICU following cardio-thoracic procedures, accounting for 7.9% of ICU admissions and 46.6% of cardio-thoracic procedures done within the review period. The mean length of stay and ventilation were 5.71 ± 5.26 and 1.30 ± 2.62 days. The most significant predictor of outcome was endotracheal intubation (P = 0.001) and overall mortality was 15%. Conclusion: There is a high utilization of the ICU by cardio-thoracic patients in our review and post-operative care was the main indication for admission. Some selected cases may be managed in the HDU to reduce the burden on ICU resources. We opine that when endotracheal intubation is to continue in the ICU, a 1:1 patient ratio should be instituted.

Aim: Acute traumatic extradural hematoma (EDH) is life threatening and requires prompt intervention. This is a study of incidence and outcome of consecutive patients with EDH managed in Enugu, Nigeria against a background of delayed referral. Materials and Methods: We retrospectively examined all consecutive trauma cases managed between 2003 and 2009 and analyzed patients with acute traumatic extradural hematoma in isolation or in combination with other intra cranial lesions. Age, sex, cause of injury, time of presentation, Glasgow Coma Score (GCS), pupil reactivity, treatment and clinical outcomes were determined. Results: Of 817 head injuries, 69 (8.4%) had EDH, a mean of 9.9 patients per year. Males were 57 (83%) and females 12 (17%). Peak age incidences were the second and third decades of life, with a mean age of 30.2 years. Causes were road traffic accidents (57%), assault (22%) and falls (9%). Twenty-six (38%) patients presented within 24 h of injury and only one patient presented within 4 h. The average time lag before presentation was 94.2 h. At presentation 39% had GCS of 13-15, 27% had 9-12 and 34% had 3-8. The most common location of hematoma was temporal (27.5%). Forty (59%) patients had surgery while 14 (20%) were managed conservatively. Ten patients (14.5%) died and of these 70% had GCS <8 and 60% had a seizure. Conclusion: We conclude that early appropriate treatment of EDH results in good high quality survival (Glasgow Outcome Score 4 or 5). Low GCS should not be an absolute contraindication for surgery. Seizure prophylaxis should be considered in patients with GCS <8.

Dysesthesias due to palmar cutaneous branch of median nerve injuries infrequently follow carpal tunnel release surgeries. Objective: To determine the course of palmar cutaneous branch of the median nerve in wrist of adult Nigerians, identify the common variations, determine its relations to the palmaris longus (PL) in the region of the distal wrist crease. And on these basis, suggest a safe incision for carpal tunnel surgery in Nigerians. Materials and Methods: Detailed anatomic dissection of the palmar cutaneous branch of the median nerve was carried out with the aid of a loupe magnification on 40 Nigerian cadaver wrists. The origin, course in the distal forearm, wrist and proximal palm was traced. Measurements of the distances between the radial and ulnar branches of the nerve and the PL were made. The distance between origin of the nerve and the distal wrist crease was measured as well. The common branching pattern of the nerve was noted. Results: The palmar cutaneous branch of the median nerve was present in all dissected wrists. The mean distance of the radial branch to PL was 0.81 cm (SD ± 0.3 cm), while the ulnar branch was 0.3 cm (SD ± 0.1 cm). from same structure. The mean distance from the origin to the distal wrist crease is 4.5 cm (SD ± 2.1 cm). We noted the terminal distal branching pattern of the nerve to be highly variable. Conclusion: The Palmar cutaneous branch of the median nerve is safe with an incision made at least 0.5 cm ulnar to the PL in carpal tunnel surgeries in Nigerians.

Background: Assault, though a major cause of maxillofacial injuries in the developed nations, has not been adequately investigated among Nigerian population. This study aimed to analyze the pattern of maxillofacial injuries caused by assault in our institution. Methods: A descriptive clinical survey of patients with assault-induced oral and maxillofacial injuries presenting to our maxillofacial surgery clinic/emergency ward was carried out. Demographic data and pattern of injuries obtained from patients' record and department trauma database were analyzed. Results: 156 patients presented with oral and maxillofacial injuries between October 2009 and December 2010. Thirty-four cases were due to assault and male to female ratio was 1.8:1. The mean age of the patients was 21.4±6.26 years (age range 2-48 years). 23.6% (n=8) of the injuries were due to domestic violence between spouses while 35.3% (n=12) resulted from fight. Students unrest and armed robbery attack accounted for six cases each (17.7%, n=6), while there were two cases due to child battering. 64.3% (n=22) of the injuries sustained involved soft tissues while 35.7% involved hard tissues. Contusion was the most common isolated soft tissue injury accounting for 56% (n=10) while dentoalveolar fracture was the most encountered hard tissue injury (62.5%, n=16). Conclusion: There is need for preventive strategies to reduce the incidence of assault-induced maxillofacial injuries.

We report case of a 28-year-old male who had extratesticular varicocele which was associated with intratesticular varicocele. The patient was referred to our department with pain in scrotal region. Routine scrotal sonography revealed extratesticular varicocele which was confirmed by color Doppler. It was associated with intratesticular varicocele. Intratesticular varicocele is a rare condition with a variable sonographic appearance. Color Doppler sonography is helpful in confirming the diagnosis. Detection of intratesticular component is essential in the management of varicoceles.

Rupture of the diaphragm is almost always due to major trauma. We present here an unusual and rare case of late presentation of diaphragmatic hernia after an innocuous injury. The patient was initially misdiagnosed as a left pleural effusion on the basis of chest X-ray and ultrasound findings. Finally, the diagnosis was confirmed on computerized scanning.

Internal hernias of the abdomen are uncommon. They represent less than 1% of bowel obstruction cases. The left Paraduodenal hernia (PH) is the most frequent type of internal hernias. We report a case of 77 year- old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal PH by showing incarcerated jejunal loops in a PH through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and to clarify the therapeutic modalities.

A 76-year-old farmer presented at our emergency unit with a history of gradual swelling of abdomen without fever, nausea, or urticaria. On examination there was symmetrical enlargement of abdomen with fluid thrill. Contrast-enhanced computed tomography scan showed that the entire peritoneal cavity was distended and occupied by multiloculated noncalcified content of mixed attenuations. Diagnosis of peritoneal seeding of hydatid cyst was made. At laparotomy, about 25 l of daughter cysts and a membrane was found in the peritoneal cavity without other organ involvement. Postoperative period was uneventful.

Hydatid cyst is the disease of liver and lungs and is common in some regions especially sheep rearing countries of the world, but this disease may occur in any part of world and anywhere in the body. This report presents primary hydatid cysts located in intramuscular region of left side of the abdomen. A 54-year-old female patient from central India, farmer by occupation, non vegetarian by diet came with chief complaints of a painless mass in the left iliac fossa, gradually increasing in size over a period of 6 months. Superficial ultrasound revealed a lesion resembling a hydatid cyst. Surgical excision was done without injuring the cyst. Diagnosis was confirmed on histo-pathological examination and was compatible with a hydatidcyst. Ahydatid cyst should be considered in the differential diagnosis of subcutaneouscystic lesions, it should be excised totally, with an intact wall and postoperative albendazole should be given to avoid recurrence.

Leiomyomas are benign tumors arising from smooth muscle of the uterus. Intravenous leiomyomatosis is characterized by intraluminal growth of benign smooth muscle into either venous or lymphatic vessels outside the limits of myoma. It commonly extends into the pelvic veins and manifests as worm-like protrusions of tumor emanating from veins at the parametrial margins of hysterectomy specimen. The tumor can cause life-threatening symptoms if it involves inferior vena cava or right atrium. We report a case of intravenous leiomyomatosis of the uterus managed at our institution.