Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25.6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs.

Sacral acupuncture was used for pain relief during labour in 30 pregnant Nigerian women. It produced clinically adequate analgesia in 19 women (63.3%). 6 women in this group (31.6%) reported that they had experienced no pain whatsoever throughout the period of labour and delivery (average duration - 8 hours). 11 women (36.7%) had no pain relief and required pethidine injection when sacral acupuncture proved ineffective. 24 women (80%), including 5 who did not obtain relief, indicated their wish to have sacral acupuncture during their next confinement. 2 women (6.7%) objected to needling, 3 considered acupuncture useless while another 2 did not believe in it. The patients' cardio-respiratory functions and uterine contractions were not adversely affected. There were no untoward effects on the mothers or their neonates. The procedure was technically simple, the equipment light and cheap. The needles did not interfere with nursing or obstetric manouvres. The procedure was however time consuming. The results were inconsistent and unpredictable. Despite these limitations, the simplicity, cheapness and absence of physiological complications associated with the procedure, make it a worthwhile medical armament for pain relief in the Nigerian environment, with limited resources and specialized manpower.

Ear acupuncture performed with indwelling auricular semi-permanent (ASP) needles, was used for the treatment of musculoskeletal pain and stiffness in 55 Nigerians. The male patients were initially reluctant to have an ASP needle stuck in their auricle, because they feared that the needle would attract embarrassing comments. No female objected to the use of these needles. The longest time an ASP needle remained in situ was 28 days (in a male), while the shortest time was 2 days. There was no associated ear lobe infection or scarification. All seventeen patients with acute torticollis had significant relief of pain and stiffness within 24 hours, scoring less than 25% (residual pain) on the visual analogue scale (VAS). Contrary to speculation auriculo acutherapy using the indwelling needles is acceptable to the Nigerian (male and female). The tropical weather does not necessarily predispose to infection at the site of needle, insertion, provided the area is kept dry. The technique is useful for the relief of musculoskeletal pain and stiffness, and permits the patient to continue self acutherapy at home without the need to return to the clinic. However, these needles are disposable and have to be imported. There is therefore the problem of availability.

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