Background and Objectives: Data on trauma in Nigeria requires updating just as trauma care needs coordination and organization. This study was done to examine the clinical spectrum of trauma and to propose measures for organization of trauma care. Patients and Methods: A 2-year prospective report of an ongoing trauma research is presented. Data obtained from include name, age, sex, presenting diagnosis at the accident and emergency (A and E) unit, injury-arrival time, mode of transportation of patients to the hospital, and the outcome of care. Results: Trauma patients comprised 2,913 of the 4,164 (70.0%) surgical patients seen in the A and E but 129 of 171 deaths (75.4%). Types of trauma were lacerations (585 patients, 20.1%), fractures (542, 18.7%), head injury (250, 8.6%), multiple injuries (249, 8.6%), burns (159, 5.5%), and others. Road traffic accidents (RTA) occurred in 1,816 patients (62.3%), falls in 308, assaults in 258, burns in 159, home accidents in 122, gunshot injuries in 107, industrial accidents in 73, and foreign body injuries in 70. There was no pre-hospital care. Transport to the A and E was done by relations, the police and a few Good Samaritans. Most of the patients reached the hospital in < 6 h. Common mortalities were from head injury (37 patients, 28.7%), multiple injuries (35, 27.1%), fractures (12, 9.3%), and burns (9, 7.0%). Of 106 deaths with timed records, 22 (20.7%), 56 (53.0%) and 28 (26.3%) occurred in 0-1 h, > 1-24 h and > 24 h, respectively. Conclusions: The spectrum of trauma is predominantly RTA-related, hence, trauma care organization would include prevention of RTA, organization of pre-hospital care aimed at transport time of < 2 h, training volunteers from the populace and the police as emergency medical services technicians for resuscitation during transport and getting patients to hospital in optimal state, and an enhanced in-hospital care by designation and categorization of hospitals. These strategies, including continuous trauma research and funding, would go a long way in reducing mortalities from trauma, especially from RTA.

The natural history of intracavitary aspergilloma, which is caused by the ubiquitous fungus Aspergillus fumigatus, remains unknown. Many reports, however, indicate that this opportunistic fungus colonises cavities in the upper lobes that result from pulmonary tuberculosis, lung cyst, lung abscess, bronchiectasis, neoplasms,' 3 sarcoidosis, and ankylosing spondylitis.4 5 The saprophyte forms a conglomeration of fragmented hyphae, fibrin, and inflammatory cells (called an aspergilloma, fungus ball, or mycetoma) with the radiological appearance of a crescent of air separating the mycetoma from the wall of the cavity.' 6-8 Patients who have old tuberculous cavities with superimposed aspergillomas tend to have recurrent and life threatening haemoptysis,5 '9-4 and this is clearly an important factor to be considered in assessing their need for surgery. Consequently, this study was undertaken to review our experience of the incidence, natural history, diagnosis, and management of pulmonary aspergilloma seen in residual tuberculous cavities in a chest clinic serving a rural and urban population where pulmonary tuberculosis is endemic. This represents the largest published series from a single institution in our geographical zone. Table 2 summarises the important clinical features in the 11 patients with aspergilloma associated with pulmonary tuberculosis. The duration of illness until presentation at the hospital ranged from one week to one and half years and the most frequent complaint was of recurrent haemoptysis, usually of one to two days' duration. Fever, productive cough, weight loss, and repeated haemoptysis with varying degrees of anaemia occurred in all patients. Five of the patients with severe or advanced pulmonary tuberculosis presented with dyspnoea and fatigue. There were four cases of finger clubbing. Clinical manifestations DiagnosisAcid fast bacilli were present in the sputum smear of nine of the 11 patients and the remaining two had 862

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We here report a case of superior vena cava syndrome in childhood. He was a 10-year-old boy with benign encapsulated thyroid tumor with predominating respiratory symptoms and signs. A rare condition in childhood seen in our hospital reported to highlight the problems of developing countries in handling the kind of emergency posed by such cases and also to raise an alarm for critical review of all oncological patients for signs of superior vena cava obstruction so that effective and appropriate management interventions could be instituted early enough to reduce mortality.