ROLE OF ABDOMINAL ULTRASOUND IN EVALUATION OF CHILDREN WITH SUSPECTED UPPER GASTROINTESTINAL DISEASE.

OBJECTIVES: To evaluate the sonographic abdominal findings in children with suspected upper gastrointestinal disease, establish indications for sonography and describe the gastrointestinal disease patterns that can be evaluated by ultrasound. DESIGN: Descriptive prospective study. SETTING: Kenyatta National Hospital and Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi. SUBJECTS: Fifty-six children who presented with vomiting and suspected upper gastrointestinal disease. Age range was from six days to 12 years with mean age of one year five months. Seventy seven percent were two years and below. RESULTS: Of the 56. children, six were normal on sonography; 18 (32.1%) had intussusception, 16 (28.6%) gastroesophageal reflux, seven (12.5%) pyloric stenosis, four appendicitis, three jejunal/ileal atresia and two enteric duplication cysts. All the children with pyloric stenosis were male. The male: female ratio for intussusception and GER was 1.5:1 and 1.6:1 respectively. The most common clinical presentation in children found to have intussusception was palpable abdominal mass, and few of them presented with bloodstained stool. More than two thirds of the children with gastro-oesophageal reflux presented with complications of recurrent pneumonia and failure to thrive. The sonographic findings correlated with fluoroscopy for GER except in two children where sonography was found to be more sensitive. The sonographic findings correlated with surgical outcome for pyloric stenosis, intussusception,jejunal/ ileal atresia and enteric duplication cysts. CONCLUSION: Trans-abdominal sonography has a definite role in investigating the child suspected to have upper gastrointestinal disease and should be considered as the initial imaging modality, instead of fluoroscopy, thereby avoiding or limiting the use of ionising radiation. Findings in this study confirm that ultrasound is an accurate, reliable and rapid screening method to evaluate the causes of upper gastrointestinal disease in children.

Comparison of sonography with venography in the diagnosis of deep venous thrombosis.

OBJECTIVE: To compare the findings of venous sonography with contrast venography in the detection of deep venous thrombosis (DVT) of the lower limbs. DESIGN: Prospective study. SETTING: The Kenyatta National Hospital, a teaching and referral hospital in Nairobi. SUBJECTS: Fifty five limbs in 44 patients with clinical suspicion of DVT were evaluated during the seven months study period (October 2002-April 2003). The ethics committee in the institution granted approval for the study and participants gave written informed consent. INTERVENTION: Venous sonography in which a three step protocol involving B-mode gray scale compression sonography, colour and colour Doppler sonography was obtained after contrast venography in patients with clinical suspicion of DVT. The ultrasound examination was done within 24 hours of the contrast venogram. RESULTS: The overall sensitivity of venous sonography was 88.9%, specificity 91.8% and accuracy 90.9%. Considering only DVT above the calf, the sensitivity improved to 100%. An alternative diagnosis was found by ultrasound in 48.6% of the negative for DVT cases. CONCLUSION: The accuracy of venous sonography as done locally is high and comparable to that in developed countries. We recommend that for patients with clinical suspicion of DVT, venous sonography be done as the initial imaging investigation and venography be reserved for those patients with equivocal or inadequate sonography results.

Biophysical profile scores and resistance indices of the umbilical artery as seen in patients with pregnancy induced hypertension.

OBJECTIVE: The role of Biophysical Profile Score and resistive index of the umbilical artery for monitoring pre-eclampsia patients. DESIGN: Descriptive prospective study. SETTING: Kenyatta National Hospital and Mater Hospital, Nairobi, Kenya. SUBJECTS: One hundred and ten cases during a three month period. RESULTS: Normal biophysical profile scores were found in 93 (84.5%), and 17 (17.5%) cases had abnormal scores ranging from mild to severe foetal distress. Resistive index of umbilical artery (RI-UA) were normal in 72 (66.1%) and high resistive index accounted for 33.9%. Intra-Uterine Growth Restriction (IUGR) was a prominent finding accounting for 30.5%. A positive relationship was shown to exist between IUGR and RI-UA and also with severity of hypertension with P-values < 0.05. Resistive index of umbilical artery was positively related to the duration of illness confirming its dependence on chronicity (P = 0.004). Resistive index of umbilical artery proved to be an earlier indicator of foetal compromise before any foetal distress becomes obvious. CONCLUSION: Regular obstetrical ultra sound foetal surveillance in pre-eclampsia patients is important for foetal wellbeing. Doppler evaluation of high risk patients is more sensitive test than the biophysical profile score.

Radiological features of Burkitt's lymphoma.

BACKGROUND: Diagnostic radiology investigations play important roles in the management of Burkitt's Lymphoma. OBJECTIVES: To document the various radiological manifestations of Burkitt's lymphoma as seen in patients at the Kenyatta National Hospital. DESIGN: Prospective study of Burkitt's Lymphoma cases admitted to the paediatric and Ear, Nose and Throat Wards. SETTING: Kenyatta National Hospital. MAIN OUTCOME MEASURES: All histological proven cases of BL had the following documented; Age sex, tribe, geographical (province) of origin, full medical evaluation results, presenting site of tumour, radiological findings and results of chest X-ray, abdominal ultrasound occipital frontal view of the skull X-ray. computerised tomography, myelography and orthopantomograms. RESULTS: In the period between April 1991 and March 1992 this study registered 49 patients age range 2 to 14 years. These were males 34 (69%) and females 15 (31%). The commonest radiological findings was associate with intra abdominal lymphoma seen in 65.2% of the cases, the least findings associated with cervical adenopathy and pleural effusion each 3.3% of cases. Twenty (41%) of the disease was clinically confined to the facial area while radiologically 25% of these were demonstrated to extend to the abdomen as well. CONCLUSION: Disease extent on radiological examination was found to be more extensive compared to clinical evaluation alone. The observation emphasised the role of radiological investigation in the management of lymphomas in this setting.