Aetiological Spectrum of Pancreaticobiliary Diseases in Adult Nigerians on Magnetic Resonance Cholangiopancreatography.

BACKGROUND: Imaging is vital for assessing pancreaticobiliary diseases. AIM: The aim of the study was to investigate the spectrum and pattern of pancreaticobiliary diseases in adult Nigerians using magnetic resonance cholangiopancreatography (MRCP). METHODS: This was a retrospective, descriptive cross-sectional study. The electronic radiological records of 110 adult Nigerians who had undergone MRCP were reviewed. The MRCP images were evaluated for bile duct dilatation, intraluminal filling defects, strictures, calculi, and other abnormalities. RESULTS: There were 45 males (40.9%) and 65 females (59.1%) aged 18-83 years, with a mean age of 51.93 ± 15.22 years. Jaundice (59.1%) and right hypochondrial pain (31.8%) were the most common presenting complaints. Gallstones (32.7%), common bile duct strictures (15.5%), choledocholithiasis (11.8%), pancreatic head carcinoma (10.9%), and gallbladder carcinoma (2.7%) were the most frequent abnormalities. There was biliary obstruction in 56.4% of participants, mostly at the distal and proximal common bile duct. Other findings include hepatomegaly (23.6%), hepatic cysts (6.4%), hepatic steatosis (0.9%), duodenal wall thickening (1.8%), and ascites (5.5%). MRCP was normal in 25 (22.7%) participants. CONCLUSION: Gallstones were the predominant pathology of the various pancreaticobiliary diseases, while Pancreatic head and gallbladder carcinoma were the most common malignant diseases.

Portal hypertension evolving from sickled hepatopathy: Could hepatic venous Doppler ultrasound be beneficial in its evaluation?

PURPOSE: Sickle cell intrahepatic cholestasis involves sickling within hepatic sinusoids leading to vascular stasis and localized hypoxia resulting in ballooning of the hepatocytes causing a direct back pressure effect with resultant intracanalicular cholestasis. Vascular stasis may ultimately lead to portal hypertension. We proposed to document findings suggestive of portal hypertension evolving from hepatopathy in steady-state sickle cell disease (SCD) patients using hepatic venous Doppler ultrasound. METHODS: This is a prospective case series of 6 SCD subjects in steady-state (median age, 30 years; range, 19-43), comprising of 3 males and 3 females, who underwent a routine Doppler ultrasound evaluation of their hepatic veins and were discovered to have an abnormal biphasic waveform pattern. Venous blood was obtained from all subjects to evaluate for P-selectin, homocysteine, foetal haemoglobin, haematocrit levels, white cell and platelet counts. Doppler ultrasound was also carried out on all subjects to evaluate for the hepatic waveform, right renal artery RI and PI along with the hepatic artery velocities. RESULTS: All the 6 subjects had reduced haematocrit (median value of 21.5%; range, 18-25%) and some degree of renal dysfunction (plasma cystatin-C ranged from 1.6 to 12.2 mg/L). Elevated white cell count, hyperhomocysteinemia, reduced SpO2(<94.0%) and reduced estimated GFR (eGFR < 90 ml/min) was also noted in 4 subjects (66.7%). Similarly, 4 subjects (66.7%) had elevated RI in the right kidneys while 3 subjects (50.0%) had elevated PI in the right kidney. CONCLUSION: Doppler ultrasound Hepatic vein waveform analysis may be a useful examination in the evaluation of patients with SCD as it may elicit feature of portal hypertension. Further studies are suggested to confirm this in a larger population of SCD patients using the gold standard.

Obesity in benign prostatic enlargement: A cross-sectional study comparing sonographic and anthropometric indices of adiposity in a tertiary hospital in Southwestern Nigeria.

BACKGROUND: Findings from studies on obesity and benign prostatic enlargement (BPE) have been inconsistent. With a previous study done in our facility showing no correlation between anthropometric indices of obesity and BPE, this study aimed at reevaluating the association between obesity and BPE using sonographic indices of abdominal/central obesity. MATERIALS AND METHODS: Ninety consenting subjects with clinically confirmed BPE had their height and weight [(to calculate body mass index (BMI)] as well as waist and hip circumference [to calculate waist-hip ratio (WHR)] done. The subcutaneous, preperitoneal, and visceral fat thicknesses (SFT, PFT, and VFT, respectively) of these subjects and their prostate volumes were measured on transabdominal Ultrasonography (USS). Transrectal USS was also done to measure the total prostate and transitional zone volumes. Data were analyzed using SPSS version 22. RESULTS: WHR and waist circumference correlated positively with SFT (r = 0.325, P = 0.002 and r = 0.370, P = 0.000, respectively) and PFT (r = 0.209, P = 0.048 and r = 0.313, P = 0.003, respectively). While BMI correlated positively (r = 0.23, P = 0.029) with transrectal transitional zone volume, all three sonographic indices of adiposity correlated negatively (SFT: r = -0.223, P = 0.035; PFT: r = -0.321, P = 0.002; VFT: r = -0.242, P = 0.021) with transrectal total prostate volume. In addition, PFT correlated negatively with transabdominal prostate volume (r = -0.222, P = 0.037) and transrectal transitional zone volume (r = -0.211, P = 0.046). CONCLUSION: The relationship of BMI with transrectal transitional zone volume was a direct one, while that of SFT, PFT, and VFT with transrectal total prostate volume as well as PFT with transabdominal prostate volume and transrectal transitional zone volume was an inverse one.