Amoebic liver abscess: the effect of aspiration on the resolution or healing time.

Recent sonographic monitoring of patients treated for amoebic liver abscess has shown the healing or resolution time varying between 10 and 300 days. The effect of percutaneous needle aspiration under or resolution time was studied in 36 patients. Nineteen patients had drugs and needle aspiration under ultrasound guide whilst the 17 patients had drugs--metronidazole, diloxanide, and chloroquine--alone. Both groups were monitored clinically and sonographically. Results showed that the abscess cavities of 18 out of 19 patients (94.7%) of the aspirated group and 10 of 17 patients (58.8%) of the non-aspirated group had resolved at the end of three weeks. The difference in response to treatment was significant (P less than 0.02) more so for lesion size more than 6 cm (P less than 0.01). There was also a more rapid clinical response in the aspirated group than in the non-aspirated group, particularly for patients whose lesion size was more than 6 cm (P less than 0.01). In conclusion, percutaneous needle aspiration is safe, enhances clinical recovery, and accelerates resolution particularly in patients with large abscess cavities.

Tibial and fibular angles in homozygous sickle cell disease.

Measurements of the tibial and fibular angles made on ankle radiographs of 34 patients with sickle cell disease were compared with those of 36 normal Nigerians. Widening of the fibular angle, which is an indication of tibiotalar slant, was demonstrated in about 79% of sickle cell disease patients. By using fibular angle measurements as an objective method of assessing subtle tibiotalar slant, it is concluded that the incidence of this deformity is much higher among sickle cell disease patients than previously reported. The mean values of tibial and fibular angles in normal Nigerians are higher than has been reported amongst Caucasians.

Pneumatisation of the maxillary sinus in normal and symptomatic children.

The pattern of pneumatisation and normal width of the maxillary sinus in 191 Nigerian infants and children whose age range was 6 months to 14 years was determined. Fifty-four percent of children with no respiratory tract or sinus infection had an opaque maxillary sinus. A figure of 44.5% was obtained amongst children with suspected bronchopneumonia. Only 41.5% of suspected cases of sinusitis, acute and chronic middle ear disease had opaque sinuses. The highest rate of sinus opacity was seen in children under 2 years who were asymptomatic. The mean maximal width of the normally aerated sinus was 8.74 mm for children under 2 years, 16.5 mm for 3-6 years, 21.5 mm for 7-11 years and 25 mm for children 12 years and above. We conclude that maxillary sinus opacity in our experience is an unreliable index for the diagnosis of sinusitis in children.

Width of the presacral space in Nigerian adults.

The width of the presacral space and the thickness of the rectal valve were measured on lateral radiographs obtained during barium enema examinations performed on 182 Nigerian adult patients over a 5-year period (1980-1984). The mean width of the presacral space was 0.78 cm, the value in men being significantly higher than in women (p less than 0.01). Although these values are similar to those reported among Caucasians, a wider range of normal values was obtained in this study. There is also no significant difference between the mean value of the rectal valve thickness of 4.3 mm obtained in this study and that obtained from previous studies.

Bone and soft tissue components of the leg in infants with protein calorie malnutrition.

The measurements of muscle, fat and cortical thickness were made on leg radiographs of 40 kwashiorkhor infants and were compared with those of 32 normal infants. There is a significant decrease in muscle cylinder ratio, an index of the contribution of muscle to calf thickness in kwashiorkhor. The loss of bone cortex in kwashiorkhor is due mainly to failure of appositional growth. The muscle cylinder ratio in normal Nigerian infants is much higher than has been reported amongst Caucasians.

Cholelithiasis in sickle cell disease: a cholecystographic and ultrasonographic evaluation in Nigerians.

A prospective study designed to establish the incidence of gallstones among 48 Nigerian homozygous sickle cell disease patients was made using oral cholecystography and grey-scale ultrasonography. The age range was 2 to 35 years with a mean of 16 years. The youngest patient with gallstones was a 51/2-year-old boy. Gallstones were demonstrated on cholecystosonography in 12 of 48 patients (25%). The incidence of cholelithiasis was 7.7% in children 10 years or younger and 31.4% in patients above this age. There was no correlation between the incidence of cholelithiasis and serum bilirubin on one hand and positive history of abdominal pain on the other. Screening of patients over 15 years for gallstones is suggested with a view to performing elective cholecystectomy in patients who subsequently become symptomatic.

Intestinal obstruction of infancy and childhood in Benin City, Nigeria.

The pattern of intestinal obstruction observed on 168 Nigerian infants and children is presented. The commonest causes of intestinal obstruction were intussusception (21%), anorectal anomalies (20%) and Hirschsprung's disease (14%). Strangulated hernia and adhesions occurring in 3.5% and 1.7% of cases respectively were notably uncommon in this age group. The role of radiology in the management of some cases is highlighted.

Mediastinal and subcutaneous emphysema associated with childhood measles.

An analysis of the clinical records and chest radiographs of seventeen children with subcutaneous and mediastinal emphysema (SCME) complicating childhood measles was made. The commonest sites of extra-alveolar air were the retrosternal space (16/17) and paraspinal (12/17). Other areas were within the inferior pulmonary ligament (7/17) and subpulmonary areas (6/17). All patients had pulmonary infiltrates. There was pneumothorax in 30% of cases. Eighty per cent of children showed subcutaneous emphysema in addition to mediastinal emphysema. There was a mortality of 12%. SCME completely resolved within 14 days in the remaining patients.

Radiology of kerosene poisoning in young children.

Chest radiographs of 75 Nigerian children with kerosene poisoning were studied. The commonest pulmonary abnormality, found in 77% of cases, was basal infiltrates. There were more severe lung changes than in previous reports. A striking seasonal variation in kerosene poisoning was observed. Interestingly, air oesophagogram and gaseous distension of the stomach were demonstrated in 23 and 25% of patients, respectively. Probable factors in pathogenesis are discussed.

Radiology of obstetric vesicovaginal fistula.

The excretory urograms of 70 Nigerian women presenting to the University of Benin Teaching Hospital with obstetric vesicovaginal fistula over a 7-year period are analyzed. The common abnormalities are medial deviation of distal ends of ureters (34%); discrete but smooth pseudoprostatic bladder base indentation (33%); and calyceal clubbing of varying degrees (19%). Other abnormalities observed include hydroureters (18%); bladder calculi (7%); bladder wall calcification (3%), and unilateral nonfunctioning kidneys (3%).

The radiological aspects of chest complication in childhood measles.

Chest radiographs of 335 Nigerian children presenting with pulmonary and cardiac complications of measles were studied systematically. Perihilar (88%) and diffuse (69%) pulmonary infiltrates were the commonest findings. Other abnormalities included segmental consolidation (34%), emphysema (20%), cardiomegaly (12%) and atelectasis (10%). Pneumothorax and pleural effusion were seen in 24 (7%) and 14 (4%) children respectively. Eight children (2.5%) had subcutaneous and mediastinal emphysema. In patients with atelectasis and segmental consolidation there was a striking preponderance of right sided lesions.