Background: Ureterocele is a cystic dilatation of the distal ureter. It remains a rare urologic condition in non-Caucasians and is even less common in adults. Single-system ureteroceles are usually found in adults, and thus the name "adult" ureterocele. Though uncommon, urologists practicing in this region should be acquainted with the management. Materials and Methods: A retrospective review of folders of 10 adult patients who were admitted for surgical treatment of ureterocele in our center between 2000 and 2009 was done. The information obtained included: age, sex, type and number of ureterocele, associated disease, type of surgical intervention, complications, and follow-up. Results: The age range was 20-49 years, with a mean age of 31 years. Of these patients, seven were females and three were males. Six patients had unilateral ureterocele while four had bilateral disease, making a total of 14 ureteroceles. The presenting symptoms were flank pain and painful micturition, each occurring in 60% of the patients. Genitourinary tuberculosis was diagnosed in 4 (40%) patients. Other associated pathologies were impacted stone in the ureterocele and vesical schistosomiasis. The treatment was mainly by open method (70%), while the rest had endoscopic treatment. All the patients did well and there were no significant perioperative complications. Conclusion: The finding of associated pathology in our patients supports the theory of an acquired origin. Urologists practicing in this region need to have a high index of suspicion and be acquainted with the variable clinical presentations, radiographic features, and treatment options in order to be able to effectively manage these occasional cases.

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Background: Gastrointestinal stromal tumors (GISTs) represent mesenchymal tumors arising from the gastrointestinal wall, mesentery, omentum, or retroperitoneum that express the c-kit proto-oncogene. In low-income countries, facilities for diagnosis are limited and the patients present late with large tumors. We present the evaluation and treatment of gastric GIST and highlight the difficulties in management of these patients in a setting of limited resources. Materials and Methods: We retrospectively reviewed patients who were managed for gastric GIST from January 2001 to December 2010 in the Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information recorded included patient's demographic characteristics, clinical presentation, treatment, operative findings, and outcome. Results: There were 13 patients with histological diagnosis of gastric GIST. Their age ranged 31-67 years, with a mean of 48 years. All the patients were symptomatic and had palpable abdominal masses at presentation. Tumor size ranged 13.4-39.5 cm. Six patients had preoperative diagnosis of GIST, including two with immunohistochemical confirmation. Overall, seven patients had complete resection of their tumors. Four patients presented with gastric outlet obstruction and both peritoneal and liver metastasis. Five patients were on imatinib which they had taken for 3-13 months. Three patients had tumor recurrence 1-3 years after complete resection. Follow-up ranged from 1 month to 4.5 years. Five patients were followed up for more than 1 year. Conclusion: Due to lack of facilities for endoscopic ultrasound guided biopsy and immunohistochemistry, preoperative diagnosis was based on clinical and radiological features. Despite the large tumor size, complete resection is associated with good control of symptoms and prolonged survival.

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Introduction: Huge cervical polyp causing diagnostic dilemma is rarely encountered in gynecologic practice. The objective of this study is to document a case of huge cervical polyp masquerading as cervical cancer seen and managed in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Case Report: A 39-year-old trader para 5 + 0 who presented at the gynecologic unit with a 7-year history of fleshy mass protruding from the vagina which had been progressively increasing in size but was reducible. Physical examination revealed severe pallor, 16-week sized abdomino-pelvic firm irregular mass, and a huge firm mass protruding through the vagina, measuring 30 cm by 20 cm. The vaginal mass was irregular in shape and occupied the whole of the vagina. The cervix was not reachable. Pelvic ultrasonography revealed features of multiple intramural and subserous fibroids and a right simple cystic adneaxeal mass about 6 cm in diameter. Anemia was corrected, and at examination under anesthesia, a diagnosis of huge cervical polyp (arising from the posterior cervix) with multiple uterine fibroids was made. She had vaginal polypectomy, total abdominal hysterectomy, and bilateral salpingo-ophorectomy using an abdomino-perineal approach. She did well postoperatively and subsequently on follow-up. Histology confirmed cervical fibroid polyp and uterine leiomyoma. Conclusion: Although giant cervical fibroid is rare, it may masquerade as cervical malignancy or uterine inversion. Proper evaluation is needed to make an accurate diagnosis.

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Olfaction is phylogenetically the oldest sense, but receives scant attention in contrast to other special senses. Smell is often taken for granted, but it is central to our everyday life and helps to protect us from harmful substances, contributes to the livelihood of many professions as well as to the nutritional status and general quality of life. Olfactory disorders are common, yet remain the least understood. This paper gives an overview of the anatomy, physiology, and management of olfactory disorders with particular emphasis on current clinical measurements of olfactory dysfunction. Literature from relevant textbooks and selected journal articles has been reviewed in this article. Olfactory disorders can be classified as conductive, sensory, and neural. Localization of olfactory centers in the brain by electroencephalography has been described recently. However, quantitative evaluation by threshold measurements and qualitative testing with identification test formats continues to be the most popular type of olfactory test in use. While treatment of olfactory disorders remains disappointing, conductive disorders are amenable to treatment. Full understanding of the olfactory organ and its pathways is essential for the development of any reliable means of testing its function and managing dysfunction. With recent developments in olfactory mapping of the brain, it won't be long before a more robust test for olfaction akin to visual acuity and auditory thresholds is developed.

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Introduction: Penetrating brain injury is a very common form of head injury all over the world. It commonly follows missile injury and impalement from assaults and fall on a sharp object. Rarely, however,self-inflicted injury from playing with a sharp object can occur. The objective of this report was to present an unusual injury from a nail that the patient was playing with. Case Report: A 7 year-old, right-handed primary two pupil presented to our center with a 2-hour history of a 6-inch nail on the head. He fell over a 6-inch nail he was holding while playing. The boy gave an account of what happened at presentation. There was no focal neurological deficit. Skull X-ray showed an orbito-cranial radio-opaque nail through the orbit. He was placed on anticonvulsant, antibiotics, and full course of tetanus prophylaxis. Neither computed tomography scan nor angiography could be done. The nail was removed successfully by craniotomy. He had an 8-week course of intravenous and oral antibiotics and had 2-year course of anticonvulsant. He has been followed up for 2 years without complications. Conclusion: Although penetrating brain injuries are common worldwide, we present the peculiar accidental injury in a child who was managed with a good outcome.

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Background: Gossypiboma is retained cotton gauze in a patient after a surgical procedure. It is generally rare with incidence ranging between 1 per 1000 and 1500. Retained gauze in the scrotum is even rarer. Gossypiboma has occurred in virtually every surgical procedure despite taking adequate precautions and performing routine gauze count. The use of radio-opaque markers and radiofrequency tags on gauze is hoped to prevent the occurrence and aid in its detection. Case Report: A 65-year-old man presented with scrotal swelling, scrotal and groin skin nodular lesions 9 months after bilateral hydrocelectomy for vaginal hydrocele. Clinical evaluation revealed bilateral hemiscrotal swellings with a thickened hyperkeratotic skin, and multiple, firm, non-tender, nodular growths on the scrotum, groin, and mons-pubis. The enlarged scrotum contained a firm non-tender mass. The phallus was edematous and tortuous. He was also found to have metastatic carcinoma of the prostate. Scrotal ultrasound scan showed bilaterally enlarged testes with distorted echo pattern and a few abscess cavities. Multiple biopsies of the groin and scrotal nodular lesions showed non-specific chronic inflammation with no evidence of malignancy. The cause of the scrotal and groin lesions could not be determined before surgery. He had orchidectomy and scrotoplasty during which gauze was found in the scrotum. Conclusion: Retained gauze in the scrotum is uncommon. Our patient presented with unusual cutaneous lesions, making the diagnosis very difficult. Foreign body reaction should be considered as a possible cause of unusual skin lesions when seen around a site of previous surgery.

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Background: Vulva hematoma is a very rare maternal injury that usually presents in the third stage of labor after a normal spontaneous vaginal delivery. Most cases develop insidiously with a sudden collapse and severe groin pain. Causes reported include imperfect repair of episiotomy and rupture of varicose vein of the vulva. We report an interesting case of vulva hematoma. Case Report: We present a case of a 22-year-old primipara referred from a peripheral hospital, having collapsed at home following an unsupervised spontaneous vaginal delivery at home 6 h earlier. At presentation, the patient was pale and in shock. There was a huge left vulva hematoma with a peri-urethral laceration up to the clitoris. Surgical treatment resulted in a good outcome. Conclusion: Vulva hematoma is a rare cause of maternal morbidity and mortality. This case reminds an obstetrician to be suspicious of vulva hematoma in a patient in shock postpartum.

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Introduction: Handlebar hernia is a specific type of traumatic abdominal wall hernia that is caused by impact of the abdominal wall against a blunt object, usually bicycle handlebars. The rarity of handlebar hernia and its frequent presentation without physical signs makes it highly susceptible to misdiagnosis which may be attended with serious consequences. We discuss the presentation and management of a case of handlebar hernia and a review of literature. Case Report: A 14-year-old boy presented to emergency department with pain at right inguinal area where the abdomen had impacted on the handlebar of the bicycle. Immediately after the accident, he noticed a swelling at the site of impact. He had no history of inguinal hernia. His examination revealed normal vital signs. There was abrasion in the right inguinal region and a reducible swelling with positive cough impulse. Abdominal ultrasound showed normal abdominal viscera and the swelling was noted to contain loop of bowel. A diagnosis of handlebar hernia was made. Through an incision over the bulge, a 10 cm loop of normal bowel found in the subcutaneous plane was reduced and the 5-cm defect in the anterior abdominal wall muscles repaired in layers. The boy remains well at 2½ years of follow-up. Conclusion: Handlebar hernia can be diagnosed based on history of mechanism of injury, careful physical examination, and high index of suspicion. Abdominal ultrasound or computed tomography is an important adjunct of management. Prompt surgical repair of the hernia is recommended to prevent incarceration or strangulation.

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Background: Pseudotumor cerebri, commonly known as idiopathic intracranial hypertension, is a rare syndrome that manifests mainly as a consequence of raised intracranial pressure. Headache is the major presenting symptom. The diagnosis of this condition is established by exclusion, with the aid of computerized tomographic scan, magnetic resonance imaging, and examination of cerebrospinal fluid tap. We present a patient with advanced invasive ductal carcinoma that was successfully managed for pseudotumor cerebri. Case Report: The patient was a 46-year-old female with stage III invasive ductal carcinoma of the right breast that was treated with modified radical mastectomy, radiotherapy, and combination chemotherapy. She had also taken tamoxifen for 8 months when she developed headache and persistent non-projectile vomiting. She had two episodes of generalized seizures with associated dizziness which resolved on phenobarbitone. She had no neurological deficits. Computerized tomographic scan of the brain revealed features of raised intracranial pressure, and there was no focal intracerebral or cerebellar lesion. A diagnosis of idiopathic pseudotumor cerebri was entertained using the modified Dandy Criteria. She responded well to acetazolamide and dexamethasone. Conclusion: Pseudotumor cerebri should be considered in cancer patients presenting with raised intracranial pressure of sudden onset in the absence of clinical and radiological evidence of brain metastases. We advocate prompt therapy in patients with pseudotumor cerebri to prevent or minimize morbidity.

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Background: Many surgical approaches have been devised for a complete scalp tumor excision. The chief aim of all techniques is complete clearance with minimal blood loss. In third world countries where resource is low, scalp tumor excision procedure has been challenging because of inadequate facilities to have a good control of bleeding during excision. Case Report: The authors described a technique of a scalp tumor excision that guarantees complete excision with minimal blood loss. This approach is specifically suitable for a low-resource setting. It is simple, inexpensive, and easy to learn. Conclusion: Hemostatic circumferential suture technique for excision of scalp tumors is described. It is suitable for third world nations with low resource. The technique is simple and very effective with minimal blood loss.

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Background: Pain is a major problem for patients with cancer and it is often perceived and regarded as inevitable. Cancer pain is treatable, however. Its undertreatment has been a major problem and this is well documented. The aim of this study is to determine the prevalence of undertreatment of cancer pain in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Materials and Methods: This was a cross-sectional study involving adult cancer patients, who were hospitalized in surgical wards of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria in the month of June 2009. The outcome of treatment and the position of the patient's clinical pain status were weighted using the pain management scale. Data obtained was analyzed using SPSS 11.5 version. Results: A total of 67 cancer patients were admitted in both male and female surgical wards. There were 27 (40.3%) males and 40 (59.7%) females. The age range was 17-75 years with a mean of 44.9 years. The study showed 33 (49.3%) patients had negative scores, 4 (6.0%) had positive scores, while 30 (44.8%) had zero score using the pain management scale score. Therefore, the prevalence of undertreatment, which is equivalent to the patients with negative score, in our center was 49.3%. Conclusion: The prevalence of undertreatment of cancer pain is high in our environment and several factors may be responsible for this high rate. There is the need for training of medical personnel and all health professionals on cancer pain management.

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Background: There is still no consensus about the best and most cost-effective surgical approach to inguinal hernia repair. This study analyzes our experience in an open, non-mesh, one-layered inguinal hernia repair. Materials and Methods: From January 2001 to December 2008, 1238 patients who underwent inguinal hernia repair at two general hospitals were retrospectively reviewed. Their age ranged from 18 to 87 years, with a mean of 45.3 ± 11.0 years. Following clinical evaluation, herniorrhaphy was done under appropriate anesthesia. Patients were discharged home the same day on oral drugs. Wound dressing was changed and sutures were removed on the 3 ^rd and 7 ^th days of the follow-up visits, respectively. Demographic information, types of hernias, associated diseases, and complications were analyzed. Results: Mean duration of symptoms before presentation was 3.4 ± 0.2 years. There were 742 patients (60.0%) with indirect hernia, 496 patients (40.1%) with direct hernia, 570 cases (46.1%) of inguinoscrotal hernia, 342 patients (27.6%) with bilateral hernia, and 33 patients (2.7%) with recurrent hernia. Local anesthesia was successful in 1046 patients (84.5%). Spinal anesthesia was used in 186 patients (15.0%). Six patients (0.5%) were operated under general anesthesia. The mean inpatient stay was 4.5 h. The average cost per patient was $99:00. The mean duration of surgery was 30 ± 2.0 min, ranging from 25 to 63 min. Postoperative pain syndrome was observed in 8.0% of cases. There was a recurrence of 2.7%. Conclusion: Single-layered tissue inguinal hernia repair under local anesthesia can be confidently performed by skilled surgeons with low complication and recurrence rate and is recommended for low-income communities.

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