Carotid doppler ultrasonography in patients with co-existing type 2 diabetes mellitus and hypertension in Nigeria

Background:The co-existence of diabetes mellitus (DM) and hypertension (HTN) has been rising globally with subclinical atherosclerotic complications. These vascular changes can be detected using carotid ultrasonography. Objectives: To determine and compare the carotid arterial structural wall changes and blood flow velocities of adults with co-existing DM and HTN with age-and sex-matched non-diabetic, non-hypertensive controls. Methods: A cross-sectional comparative study of 300 participants comprising 200 adults with co-existing DM and HTN and 100 age-and sex-matched controls was done. Their carotid arteries were examined bilaterally for plaques, carotid intima media thickness (CIMT) and flow velocities ­peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI) using 4­12MHz linear array transducer. Visceral obesity and serum lipids were also assessed. Results: The mean age of the subjects was 56.13 ± 6.93 years; they comprised 38% males and 62% females. The subjects' CIMT was statistically significantly higher (p = 0.001) with a three-fold mean increase (45.5%) compared to the controls (13.7%). Lower flow velocities but higher indices were also observed in the subjects. Strong and significant correlations were observed between EDV and PI r =-0.663, p=>0.001), EDV and RI (r = -0.661, p=>0.001) and PI and RI (r =0.988, p= >0.001)among the subjects. Conclusion: Significant reduction in flow velocities with increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, carotid ultrasonography should be mandatory in individuals at risk for early detection and possible prevention of atherosclerotic complications.

Apple Peel Small Bowel, A Review of Four Cases Surgical and Radiographic Aspects.

Background: Although apple peel intestinal atresia is rare and is associated with a high mortality and morbidity, there is a dearth of its report in African literature. This study reviews four of the cases seen in a state teaching hospital in Lagos, considering the radiographic findings, surgical management and outcome. A brief review of literature is also undertaken. Aims and Objectives: To correle the plain radiographic findings with the surgical findings of neonates gathered over a six year period and to evaluate their surgical management, hoping to further help improve management of such neonates’ in future in resource limited regions such as ours. Methodology: It was a retrospective case series of four neonates who were brought in over a period of six years and operated after an initial plain abdominal X-ray. They were done as emergency cases, consent was obtained from their parents and the study was approved by the research and ethics committee. Operative findings were subsequently correlated with their radiographic findings and the surgical outcomes and follow up were documented. Conclusion: This study revealed that “the triple bubble sign” is a common radiographic finding in Apple Peel deformities, as well as gangrene of the jejunum and ileum at surgery.

Swollen Forearm in an 11 year Old Nigerian Boy

The diagnostic challenges in an 11 year old boy with a swollen forearm in a resource limited country; Nigeria; is discussed; with a brief review of literature of the causes of forearm swelling in a child and vascular malformations. This case is presented because of the rarity of arteriovenous malformation and the difficulty in making a diagnosis due to its low level of suspicion as a differential diagnosis. In this country where there is paucity of vascular surgeons; the challenges of management of arteriovenous malformations and the various imaging modalities are discussed

Multiple neurofibrosarcoma in a patient with Neurofibromatosis-1 : a case report

Neurofibromatosis-1 is a multi-systemic; genetic and progressive disease. The patients have an increased risk of malignant transformation. Neurofibrosarcoma is rare but when it occurs; may pursue an aggressive course. This case report is of a 30-year-old female patient who first presented at the University of Calabar Teaching Hospital in November 2004 with a neurofibrosarcoma of the right foot complicating a neurofibroma of the same foot first noticed 27 years earlier. She had a right below knee amputation. Fourteen months later she presented with a huge tumour involving the right lower and middle lobes for which a right lower and middle lobectomy was done. The histology of the specimen confirmed neurofibrosarcoma. In the developing world late presentation is common with increased risk of malignant transformation. Early diagnosis and follow-up; genetic coun- selling of patients and relations on early presentation would improve outcome

Angiomyolipoma : a report of two cases

Objective: We report two cases of unusual renal tumours in two Nigerian adults. The first case was in a 45 year old female; who presented with an insidious onset of right upper abdominal pain with right abdominal swelling. The second case was a 33 year old pregnant lady; presenting with three week history of right lumbar pain and an accompanying mass. The various modes of radiological investigations and their significance in making a prompt diagnosis are highlighted. Method: Abdominal ultrasound scan; intravenous urography and CT scan confirmed the presence of renal masses in both cases and the suspicion of renal malignancies were raised clinically. They both had nephrectomy. Results : Histology report of the masses revealed angiomyolipoma (AML). Conclusions: In a period of three years; out of twenty four solid renal tumours operated upon in the Lagos State University Teaching Hospital (LASUTH); two were unusual. All the others were renal cell carcinoma. All diagnosis were confirmed histologically