Ultrasonographic Hepatosplenic Parenchymal and Blood Flow Changes in Children with Acute Falciparum Malaria.

BACKGROUND: Malaria, a major cause of morbidity and mortality in Nigerian children, is associated with biochemical, haematological, blood flow and clinical multiorgan changes, including changes in the spleen and the liver. OBJECTIVES: To investigate hepatosplenic pathologies in a Nigerian children cohort with acute P. falciparum malaria. METHODS: A prospective case-control study of 260 children (65 uncomplicated malaria (UCM),65 complicated malaria (CM) cases and 130 controls) aged six months to six years. All subjects had laboratory tests and hepatosplenic parenchymal and blood-flow ultrasonographic evaluation. RESULTS: Mean splenic length was 8.13cm (95% CI: 7.84cm, 8.41cm) and 7.42cm (95% CI: 7.13cm, 7.71cm) in CM and UCM (p=0.001) respectively, liver span was significantly different in controls and CM (p<0.001); controls and UCM (p=0.014). Portal vein flow velocity was 32.5cm/s, 25.4cm/s and 26.5cm/s in controls, UCM and CM (p=<0.001 and 0.004 respectively) while splenic flow velocity was 30.7cm/s and 25.8cm/s in controls and CM (p=0.022). Splenic artery peak systolic velocity (PSV) =73.78cm/s, 66.52cm/s and 59.35cm/s (p = 0.008) among controls, UCM and CM respectively. There was significant correlation between malaria parasite (MP) density and splenic length (r =0.239, p = 0.007), splenic artery pulsatility index (PI) (r = 0.300, p = 0.001), splenic artery resistivity index (RI) (r = 0.260, p = 0.003) and liver span. CONCLUSION: In children with acute malaria, the splenic vessels and portal vein blood flow velocities were reduced. High malaria parasite density evokes direct relationship with spleen and liver span, splenic artery RI and PI and portalvein diameter.

CONTEXTE: Le paludisme, une cause majeure de morbidité et de mortalité chez les enfants nigérians, est associé à des modifications biochimiques, hématologiques, de la circulation sanguine et de plusieurs organes cliniques, y compris des modifications de la rate et du foie. OBJECTIFS: Étudier les pathologies hépatospléniques dans une cohorte d'enfants nigérians atteints de paludisme aigu à P. falciparum. MÉTHODES: Une étude prospective cas-témoins de 260 enfants, 65 cas de paludisme simple (UCM), 65 cas de paludisme compliqué (CM) et 130 témoins) âgés de six mois à six ans. Tous les sujets ont subi des tests de laboratoire et une évaluation parenchymateuse hépatosplénique et échographique du flux sanguin. RÉSULTATS: La longueur splénique moyenne était de 8,13 cm (IC à95%: 7,84 cm, 8,41 cm) et 7,42 cm (IC à 95%: 7,13 cm, 7,71 cm) en CM et UCM (p = 0,001) respectivement, la contrôles et CM (p<0,001); contrôles et UCM (p = 0,014). La vitesse d'écoulement de la veine porte était de 32,5 cm / s, 25,4 cm / s et 26,5 cm / s chez les témoins, UCM et CM (p = <0,001 et 0,004 respectivement) tandis que la vitesse d'écoulement splénique était de 30,7 cm / s et 25,8 cm/ s chez les témoins et CM (p = 0,022). Vitesse systolique maximale de l'artère splénique (PSV) = 73,78 cm / s, 66,52 cm / s et 59,35 cm /s (p = 0,008) parmi les témoins, UCM et CM respectivement. Il y avait une corrélation significative entre la densité du parasite du paludisme (MP) et la longueur splénique (r = 0,239, p = 0,007), l'indice de pulsatilité de l'artère splénique (IP) (r = 0,300, p = 0,001), l'indice de résistivité de l'artère splénique (RI) (r = 0,260, p = 0,003) et la durée hépatique. CONCLUSION: Chez les enfants atteints de paludisme aigu, les vaisseaux spléniques et la vitesse du flux sanguin de la veine porte ont été réduits. Une densité parasitaire élevée du paludisme évoque une relation directe avec la rate et le foie, l'artère splénique RI et PI et le diamètre de la veine porte. MOTS CLÉS: Paludisme aigu à falciparum, foie, rate, circulation sanguine, échographie.

Evaluating Ultrasound Determined Thyroid Volume as a Predictor of Newborn Thyroid Hormone Function.

BACKGROUND AND OBJECTIVES: Congenital hypo-thyroidism is a cause of intellectual and developmental disabilities in the newborn. Early screening and prompt treatment can prevent the devastating outcomes of congenital hypothyroidism. The disease burden of congenital hypothyroidism in Nigeria is higher than in many parts of the world. Using ultrasound, the authors sought to determine the normal mean thyroid gland volume in newborns and establish the thyroid gland volume as a predictor of thyroid hormone function in the newborn. METHODS: This was a descriptive cross-sectional study. Healthy newborns had their length and weight measured, thyroid ultrasound scan performed, and a blood sample taken for thyroid-stimulating hormone values. RESULTS: The mean total thyroid volume was 0.51cm3 ± 0.25. The thyroid volume of the right lobe (mean volume= 0.27cm3 ± 0.13) was significantly larger than the volume of the left lobe (mean volume =0.24cm3 ± 0.12) (p<0.001). The thyroid-stimulating hormone (TSH) values ranged from 1.36µIU/ml to 35.03µIU/ml with a mean value of 7.73µIU/ml ± 7.04. There was no significant correlation between the thyroid volumes and the TSH of the newborns. CONCLUSION: This study determined the mean thyroid volume in newborns. There was no significant correlation between the thyroid volumes and the TSH values of the newborns implying that the thyroid gland volume is not a reliable predictor of thyroid hormone function. Newborn, Ultrasound.

MAGNETIC RESONANCE IMAGING PATHOLOGICAL EVIDENCE IN PATIENTS WITH LOW BACK PAIN IN SOUTHWEST NIGERIA.

BACKGROUND: Low back pain, a condition that affects many individuals worldwide during their lifetime is receiving increasing attention due to the attendant chronic disability, absenteeism from work, loss of earning power, loss of quality of life and finances. Recently focus has been on the rising prevalence and search for steps to address low back pain risk factors now known to be modifiable. For the evaluation of low back pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice. AIM: To determine the prevalence and distribution of lumbosacral spine discs, osseous, ligamentum flavum and facet joint changes evaluated by MRI. And to further understand the lumbosacral spine biomechanics of MRI-related disco-osseous abnormalities among native African population with low back pain. STUDY DESIGN: This was a retrospective study. SETTING: University College Hospital, Ibadan, Nigeria. METHODOLOGY: The Lumbosacral spine T1W and T2W sagittal and axial images and post gadolinium contrast images generated using a low field MRI scanner and body surface coil, in patients with low back pain, were evaluated in line with pre-defined spinal changes. RESULTS: There were a total of one hundred and eight low back pain patients who had Magnetic resonance imaging between March 2015 and August 2016 in this study with a mean age of 49.9 years and a range of 8 to 77 years. There were 28(25.9%) patients aged 50 - 59 years; this age bracket had the highest number while those aged 20 years and below were 3.7%. In all, 80(74.1%) subjects had chronic low back pain. Abnormal Magnetic resonance findings were reported in 96.3%. Multiple disc affectation was seen in 75.3%; disc bulge (79.8%) was the commonest disc findings followed by dehydration in 74.0%. The L4/5 discs were commonly affected in disc dehydration in 59(76.6%) cases, anterior herniation in 22(61.1%) cases, ventrolateral herniations in 9(81.8%) cases, nerve root compression in 21(60%) cases, facet joint hypertrophy in 17/24(70.8%) cases and spinal canal stenosis in 32/47(68.1%) cases. Vertebral end plate changes occur mostly at L4 and L5 (74% at each level). CONCLUSION: This study has shown that Magnetic Resonance Imaging changes in low back pain involved multiple discs and multilevel osseous pathologies, however, disc abnormalities are predominant. The L4-5, L5-S1 disc levels and L4 vertebra body were the most commonly affected sites among a native African population.

Prevalence of abnormal bone mineral density in hiv-positive patients in ibadan, Nigeria.

BACKGROUND: There have been reports of high rate of abnormal bone mineral densities (BMD) among people living with HIV. Following the introduction of combination antiretroviral therapy (CART) into Nigeria, the country is now home to increasing population of HIV positive patients. There is paucity of data about osteoporosis/osteopaenia and bone mineral density in this population. AIM AND OBJECTIVES: The aim of the study was to determine the prevalence and determinants of osteopaenia/osteoporosis in a cohort of HIV-positive patients in Nigeria. PATIENTS AND METHODS: The BMD of a group of patients attending the outpatient clinic of the University of Ibadan, Nigeria was assessed using a DXA machine. The relationship of bone mineral density to body weight, CART status, protease inhibitor use, and gender was investigated. Their CD4 counts and viral load were also estimated. RESULTS: A total of 1005 patients participated with a mean age of 41.3 ± 10 years. There were 724 females (72.0%) and 29.7% were single. The median length of diagnosis was 2 years (Range 1-18 years). The Median CD4 count was 371cells/ml and Median viral load was 200 copies/ml. Of this sample, 785 (78.1%) were on CART with 99 (12.6%) on protease inhibitor. The mean body mass index (BMI) was 23.7±4.7 with 9.2% underweight and 10% obese. The prevalence of osteopaenia and osteoporosis were 46.6% and 31.9% respectively, while 19.6% had normal bone mineral density (BMD). Osteoporosis was significantly higher in those aged above 40 years (p= 0.00001), the females (p= 0.022), the single (p=0.028) and the underweight (p=0.0001). There was no significant difference in BMD of those with or without protease inhibitor containing medications as well as treatment naïve patients. CONCLUSION: A high prevalence of abnormal bone mineral density was found in HIV positive patients in Nigeria. Patient age above 40 years and a body mass index class of underweight were significant associated factors. Routine bone mineral density assessment is recommended as an adjunct in the evaluation of HIV positive patients in Nigeria.

Low field MR imaging of sellar and parasellar lesions: experience in a developing country hospital.

BACKGROUND: Magnetic resonance imaging (MRI), an advancement which followed computed tomography (CT) is expensive and inaccessible in most developing countries. However it is the procedure of choice in evaluating sellar and parasellar lesions. Its major advantages are its superior soft tissue contrast differentiation, its capacity for multiplanar imaging and nonexistence of ionising radiation. Its use is relatively new in Nigeria, a developing economy in Africa. Since its introduction in 2005, it has been utilised extensively for neuroimaging at the University College Hospital (UCH), Ibadan; a large hospital in south-western Nigeria. OBJECTIVE: To review the role and pattern of low field MR Imaging in sellar and parasellar lesions presenting to a tertiary care centre in Nigeria. METHODS: All 62 patients with clinically suspected sellar and parasellar masses, referred to the Department of Radiology, UCH Ibadan for MRI between December 2006 and January 2010 were retrospectively analysed. The examinations were performed using an open 0.2T permanent magnet MR unit. T1W, T2W, T2/FLAIR, TOF and T1W post gadolinium DTPA sequences of the sellar region were obtained. RESULTS: Of the 62 patients, there were 27 males and 35 females. The modal age group was 40-49 years with a mean age of 39.94 years (±16.65 years). Twenty-four cases (38.7%) had histological diagnosis, of which 20 (83.3%) were consistent with initial MRI diagnosis. Pituitary adenomas were the commonest (58.06%) lesions of the sellar and parasellar regions. Others include parasellar meningiomas, cranipharyngiomas, and giant aneurysms. Headache and visual impairment were the major presenting features and showed no significant correlation with tumour size. CONCLUSION: The use of low field MRI in the diagnostic evaluation of patients with suspected sellar or parasellar lesions in developing countries of low economic resource is commendable as it provides beneficial outcomes in management.

The lumbosacral radiographs in the initial screening of low back pain - is one view enough?

BACKGROUND: Radiological imaging is mandatory, when investigating patients with low back pain (LBP). A minimum of three plain radiographic views of lumbosacral spine are routinely requested for by the attending clinicians. OBJECTIVE: This study is therefore carried out to determine if only one view will be sufficient in the initial screening of patients with low back pain. MATERIALS AND METHODS: The antero-posterior (AP) and lateral plain radiographs of patients referred to the radiology department on account of low back pains in an eighteen month period (June 2007 to November 2008) were reported by two certified radiologists. The findings were subjected to statistical analysis. The Kappa agreement for the two independent reports was between 0.602 and 0.908. RESULTS: The radiographs for 638 patients were reviewed. 365 (57.2%) were females and 273 (42.8%) were males. The age ranged from 20 years to 85 years with a mean of 56.4 years. Within the age group of 20-69 years, females were found to significantly present earlier than men with LBP (P< 0.041). The AP view had a significantly higher rate of reported normal findings that the lateral view (P<0.000). Osteophytic outgrowth was the commonest finding in both views although the rate of detection was higher on the lateral view, as with the other abnormal findings. CONCLUSION: This study shows that the lateral radiographs show significantly more findings than AP on plain radiographs. It is therefore recommended that lateral radiograph is adequate in the initial screening of patients with low back pain.

Early endoscopic realignment of traumatic anterior and posterior urethral disruptions under caudal anaesthesia - a 5-year review.

OBJECTIVE: We recently described early rigid retrograde endoscopic realignment of the disrupted urethra under caudal anaesthesia in the outpatient setting. This retrospective study was performed to evaluate our medium-term results. PATIENTS AND METHODS: A retrospective review of patients who had early rigid retrograde endoscopic realignment of traumatic urethral disruptions in our institution over a 5-year period was done and the relevant data extracted and analyzed. RESULTS: Fourteen acutely ruptured urethras (10 posterior and four anterior) were endoscopically realigned early in the study period. Nine (90%) of the posterior disruptions occurred at bulbo-membranous urethra (distal to the external sphincter mechanism). Thirteen of the ruptured urethras (93%) were successfully realigned (nine posterior and four anterior) and postoperative clean intermittent self-calibration (CIC) was instituted in 10 patients. The mean follow-up period was 36.6 months (range 18-54 months). The mean operating time and the median hospital stay were 22 min (range 8-68 min) and 3 days (range 1-10 days), respectively, and were shorter in patients with injuries of the anterior urethra than those with posterior urethral tears (p < or = 0.0001). Post-realignment, all 13 patients were potent and continent. Two patients required additional procedures (direct vision internal urethrotomy or urethral dilation) and one patient has remained on CIC i.e. a stricture rate of 21%. CONCLUSION: Early retrograde endoscopic realignment under caudal analgesia is suitable and cost-effective for patients with acute traumatic urethral disruptions and has good medium-term results. In addition, an early postoperative regimen of CIC significantly reduced stricture-formation in our series.

Bilateral congenital cystic adenomatiod malformation of the lungs: a case report.

A six weeks old infant presented with scalp ulcer and fever. and on examination was found to have resonant percussion notes bilaterally. The initial chest radiograph revealed multiple lucencies which were initially thought to be due to diaphragmatic hernia, but the dilemma was resolved by Computerised tomography which revealed the lucencies to be multiple cysts characteristics of Congenital Cystic Adenomatiod Malformation (CCAM) type II.

Computed tomography and childhood seizure disorder in Ibadan.

BACKGROUND: Computed Tomography (CT) is an important tool for neuroimaging, it offers an opportunity to investigate structural lesions as a cause of seizures with little morbidity. This study is designed to evaluate it's applicability in children with epileptic seizures. METHOD: It is a descriptive study of the CT scans of the 103 consecutive children who were referred to the CT suite of the University College Hospital on account of seizure disorders over a 5 year period (1997--2001). RESULTS: Only 103 (4.6%) of the subjects who had cranial scans done in five years were children with seizures disorders. The CT scans were abnormal in 53 (51.5 %). Hydrocephalus was the most common finding in 14 (13.6%). Cerebral atrophy and infarct were reported in 10.6% and 8.7% respectively. The outlined cranial fractures found in 6.8% were all depressed. A high incidence (74.4%) of abnormal scans was reported in the children with partial seizures. Thirty-three (62.3%) of the abnormal scans were amenable to surgery. The presence of neurologic deficit increased the yield of abnormal CT features. CONCLUSION: CT scans are of extreme value in the screening and definitive evaluation of seizures in children. It is advocated for excluding treatable conditions and monitoring progression of the disorder.

An unusual presentation of congenital bronchoesophageal fistula.

We present the case of a 5-week-old neonate with multiple congenital abnormalities including a broncho-oesophageal fistula, which showed radiological features suggestive of congenital diaphragmatic hernia. Emergency limited barium swallow done was initially reported as a case of diaphragmatic hernia. Autopsy revealed pus within the right lung, and a fistulous connection between the oesophagus and an intralobar sequestrated lung. No diaphragmatic hernia or intra-abdominal organ abnormality were seen, and an occipital meningomyelocoele was also confirmed.

Occult metastatic follicular thyroid carcinoma masquerading as a soft tissue sarcoma of the gluteal region.

This is a case of an occult follicular thyroid carcinoma in a 61 year old civil servant presenting with bony metastasis to the left iliac bone twenty years after an initial subtotal thyroidectomy. There was a soft tissue mass with associated cup shaped Iytic detruction of the iliac bone and on ultrasound scan the mass was found to be of mixed echogenicity and areas of sonolucencies which were due to necroses. At autopsy, the thyroid gland appeared macroscopically within normal limits but histology confirmed Follicular Thyroid Carcinoma.

Rigid retrograde endoscopy under regional aneasthesia: a novel technique for the early realignment of traumatic posterior urethral disruption.

Traumatic disruption of the posterior urethra usually occurs in association with pelvic fractures and may result in significant morbidity. The management of this injury remains difficult and controversial. Recently, early restoration of urethral continuity in these patients using either both antegrade and retrograde cystoscopy (with or without fluoroscopy), or flexible retrograde urethroscopy alone under general aneasthesia, has been reported with good results. These procedures have been proposed as an improvement over the traditional teaching of placement of a suprapubic catheter followed by delayed open repair (urethroplasty). We now describe a novel method of restoration of urethral continuity by rigid retrograde endoscopy alone under caudal aneasthesia in the early post-trauma phase. This procedure can be carried out in an outpatient endoscopic suite with standard (endoscopic)optical urethrotomy equipment and is suitable for most patients with prostatomembranous urethral disruptions. A 'high-riding' prostate is however a relative contraindication for this procedure. To date, we have carried out this procedure successfully in 4 of 5 patients with traumatic prostato-membranous disruption (a success rate of 80%). We recommend that early retrograde rigid endoscopic realignment under regional analgesia should be considered as a management option in patients with traumatic disruption of the posterior urethra.

Metacarpal index in Nigerian adults and children.

The metacarpal index (MI) is used in screening for patients with arachnodactyly especially Marfan's syndrome. It is a radiographic measure of the slenderness of the 2nd-5th metacarpals, which was measured in a total of 608 Nigerians of which 55 (9%) were children and 553 (91%) were adults. The study shows that the MI increases steadily in children approaching the adult value at about the age of 9 years in females and 13 years in males coinciding with menarche and puberty respectively. A metacarpal index of up to 11 can be considered to be within normal limits for a Nigerian adult. In both children and adults, the MI was found to be higher in females than in males. In both sexes the metacarpal index for the left hand in the adult subjects is generally higher than that of the right hand, but in children, no significant difference is observed. As in other Africans, Nigerian adults have a higher MI than Caucasians.

A case of adrenal myelolipoma mimicking pheocromocytoma.

A 34 year-old hypertensive para 2 + 0 (1 alive) woman, was found to have right suprarenal mass during routine ante-natal investigation. The suprarenal mass, which was initially diagnosed as phaeochromocytoma was excised and was found at histology to be myelolipoma! The radiological investigations and appearances (compared with phaeochromocytoma where necessary) have been discussed. The complications, differential diagnoses and treatment were also mentioned.

Case report--abdominal cocoon.

Abdominal cocoon is a rare cause of acute intestinal obstruction seen almost exclusively in young adolescent females. Almost all cases are diagnosed at surgery and cured by excising the fibrous cocoon. This case although diagnosed accidentally too was treated conservatively successfully.