Ipsilateral fracture of the head and neck of femur with partial fusion to the acetabulum

A fracture of the head and neck of the right femur in a 50-year-old man was complicated by fusion of a large portion of one head fragment to the acetabulum as a result of prolonged walking on the fractured hip. This unexpected complication made management difficult as facilities for a total hip replacement were not immediately available.     

Response to pneumococcal vaccination in normal and post-infected Nigerians

Twelve patients who had recovered from pneumococcal infections and 12 household controls were given a polyvalent pneumococcal vaccine. Adequate amounts of antibody were detected by radioimmunoassay before immunisation in controls and patients. More controls responded to nine pneumococcal polysaccharides than did patients. A transient state of unresponsiveness to vaccine may exist in some patients for a period of 4-6 weeks after infection. The high concentrations of antibody before immunisation in adult controls suggest adequate herd immunity to the endemic serotypes in the adult population.     

Meningococcal antigen in diagnosis and treatment of group A meningococcal infections

Meningococcal antigen was measured by countercurrent immunoelectrophoresis in the blood and cerebrospinal fluid of 200 patients with group A meningococcal meningitis. Antigen was detected in the blood of 27 (13.5 per cent) patients. These patients had a worse prognosis and a higher incidence of allergic complications, such as arthritis and vasculitis, about 5 days after the start of antibiotic treatment. Antigen was found in the CSF of 129 (67.5 per cent) patients; antigen often persisted in the cerebrospinal fluid despite antibiotic treatment before admission. A combination of immunoelectrophoresis and routine bacteriologic study was used in the diagnosis of 162 (84.8 per cent) patients with meningococcal meningitis. High levels of antigen and a slow antigen disappearance were associated with neurologic damage. The antigen is stable and may be detected from specimens of cerebrospinal fluid dried on filter paper.     

Closed digital commissurotomy for mitral stenosis in Northern Nigeria

Despite the absence of sophisticated thoracic surgical facilities, valuable relief was provided to young patients with progressive symptoms of rheumatic mitral stenosis in Zaria (Nigeria) whose response to the medical regime had been unsatisfactory. Using digital trans-atrial commissurotomy, which is technically straightforward and involves little blood loss and no elaborate surgical equipment 18 patients with a lone mitral stenosis were symptomatically improved but three with mixed mitral stenosis and regurgitation died. There is urgent need to reduce the prevalence of rheumatic fever in this and other parts of the tropics.     

Orchidectomy in a rural African population

From 1971 to 1977 in Zaria, Nigeria, orchidectomy was performed on 341 men, mostly in the third to sixth decades of life. The testis itself was diseased only in 21% of cases. Torsion of the spermatic cord with testicular infarction occurred in 11% and cancer was present in less than 2%. Orchidectomy was performed therapeutically in 5% of the patients. The major causes for testicular resection were complicated and large inguinal herniae and hydroceles. These two conditions are a source of socio-economic hardship and considerable morbidity in a farming population. It would thus be worth while to include facilities for surgery of small herniae and hydroceles in plans for rural health care.     

Endotoxaemia in Vibrio El Tor cholera

Endotoxaemia and endotoxin-induced changes were sought in Nigerian patients presenting with cholera/diarrhoea. The organism was Vibrio cholerae, bio-type El Tor, serotype Hikojima. The limulus amoebocyte lysate gelation test was used qualitatively by the clot method, whilst a spectrophotometric method was used quantitatively to measure endotoxin levels. 25 acutely ill patients tested had detectable endotoxaemia by the Escherichia coli endotoxin standard. The highest endotoxin level was found in a patient with sub-conjunctival haemorrhage. Changes in platelet counts, the detection of complement breakdown product C3d in plasma, the elevation of fibrin degradation products, the finding of elevated, normal or depressed C3 levels and the absence of circulating immune complexes, suggest a pathogenic role for endotoxin in Vibrio cholerae El Tor diarrhoea.     

Partial characterization of a malaria mitogen.

Supernatants from 24-hour cultures of Plasmodium falciparum-infected human red blood cells stimulated lymphocytes from both malaria immune and malaria non-immune donors. Both T and B lymphocytes responded. Amalaria parasite-derived mitogen may play some part in the pathogenesis of the hypergammaglobulinaemia characteristic of malaria.     

Hepatitis-B virus infection in children and adults in Northern Nigeria: a preliminary survey

Hepatitis-B surface antigen (HBsAg) and its corresponding antibody (anti-HBs) have been detected by radio-immunoassay in children and adults and in adult expatriates in Zaria, Northern Nigeria. The exposure rate to hepatitis-B virus (frequency of HBsAg and anti-Hbs) was found to vary from 59% in children under five years to 72·5% in adults over 30 years of age, while the frequency of HBsAg alone was 40% and 10% respectively. The anti-HBs prevalence rates rose progressively with age and reached a peak at 62·5% in adults. Five of 32 adult expatriates (15·6%) were positive for anti-HBs. The factors contributing to the high exposure rate in the indigenous population in this region require further study to enable judicious use to be made of preventive measures.     

Successive ruptures of the ligamenta patellarum in a young Nigerian: a case report

A 34-year-old Nigerian man had successive ruptures of the ligamenta patellarum repaired 2 years after the first injury. One knee was injured at a soccer match, the other 5 months later subsequent to a minor fall. There was no evidence of systemic disease. In spite of delay in effecting treatment, the outcome was satisfactory.