ULTRASOUND IMAGING AND PATHOLOGIC FEATURES OF IDIOPATHIC SCROTAL CALCINOSIS IN A YOUNG ADULT NIGERIAN AND REVIEW OF THE LITERATURE.

Background: Idiopathic scrotal calcinosis is a rare and benign disease of the scrotal skin that presents as solitary or multiple painless calcified nodules or papules in the absence of systemic disorders of calcium or phosphorus metabolism. Although some theories have been proposed as to the cause of this rare disease, the exact cause remains unknown. In a resource-poor medical setting like Nigeria, a confident diagnosis of this condition can be made with ultrasonography. Objective: The objective of this report is to emphasize the role of ultrasound in the imaging diagnosis of idiopathic scrotal calcinosis. Case Presentation: This is a case report of a 38-year-old man who presented with recently discharging but longstanding multiple painless scrotal nodules of 22-years duration. Conclusion: This case illustrates the prompt and accurate diagnosis of idiopathic scrotal calcinosis using an ultrasound, a readily available imaging modality in a low-resource setting.Although histology remains the gold-standard for diagnosing idiopathic scrotal calcinosis following surgical excision, this benign disorder has unique sonographic characteristics that could aid the radiologist in making a confident diagnosis.

Sonographic Evaluation of Deep Vein Thrombosis in Hospitalized Neurosurgical Trauma Patients in Ibadan, Nigeria.

BACKGROUND: Deep vein thrombosis (DVT) is a major cause of morbidity and mortality in hospitalized trauma patients. Ultrasonography (US) has replaced venography as the initial diagnostic tool for DVT. AIMS: The study aimed to determine the incidence of lower limb DVT in hospitalized neurosurgical trauma patients in hospitalized neurosurgical patients. It also aimed to determine the effect of combined thrombo-prophylaxis on the incidence of lower limb deep DVT relative to a single regimen. PATIENTS AND METHODS: This was a prospective study of 154 adult neurotrauma patients who consecutively had lower limb Doppler ultrasound, initially within 72 hours of admissions and subsequently weekly or when DVT was suspected for the first 3 weeks of admission. The study spanned a 12-month period. The data generated were analyzed using the statistical package for social sciences software version 20, Chicago IL. Inc. Chi-square test was used to compare the outcome (DVT incidence) between single and combined prophylaxis groups. RESULTS: The study participants consisted of 116 (75.3%) and 38 (24.7%) cases of head and spine injuries, respectively, with a mean age of 38.8 ± 6.3 years and 85.1% being males. A total of four cases of DVT were detected during the study period, with the majority of the cases (3) detected within the first week of admission, giving an incidence of 2.6%. All four cases of DVT were detected in patients on single thrombo-prophylaxis (4/55 = 7.3%), while none was found in those on a combined regimen (0/34, P = 0.046). CONCLUSION: Most cases of DVT developed in the first week of hospitalization. Combined thrombo-prophylaxis was more effective than single regimen at reducing rate of DVT in neurosurgical trauma patients. Routine Doppler ultrasound DVT surveillance should be part of the management protocol for neurosurgical trauma patients on admission to increase DVT detection and prevent possible fatal pulmonary embolism.

Comparative evaluation of carotid intima media thickness in paediatric type 1 diabetic children and healthy children in Ibadan and Lagos, Nigeria

Patients with type 1 diabetes are at greater risk of cardiovascular disease and atherosclerosis. Carotid in-tima­media thickness (CIMT) measured by ultrasound is a marker of atherosclerosis and can predict future cardiovascular events.The aim of this study was to measure the CIMT in paediatric type 1 diabetes patients in Ibadan and Lagos and compare results with the CIMT of non-diabetic healthy control children. Carotid ultrasound was performed and CIMT measured in 70 subjects (35 diabetic patients and 35 non-diabetic controls matched for age and sex). Mean age was 12.8±3.2 years. A slightly higher, but non-significant mean CIMT was seen in diabetic cases: mean values in type 1 diabetes patients were 0.475±0.068 and 0.476±0.069 (right and left respectively) while in controls, mean values were 0.467±0.064 and 0.468±0.054 (p=0.618 and 0.575 respectively). The CIMT in both groups correlated positively with age and body mass index (BMI). Significantly higher mean CIMT values were seen in males with type 1 diabetes on both sides. However, there was no significant correlation between CIMT and duration of illness, insulin dosage, or blood pressure. CIMT is a safe and convenient measurement, which may be helpful in predicting an increased risk of future cardiovascular disease in children with type 1 diabetes

Detection of Urinary Tract Pathology in Some Schistosoma haematobium Infected Nigerian Adults.

Screening for Schistosoma haematobium infection and its possible morbidity was carried out in 257 adult participants in Eggua community, Ogun State, Nigeria. Parasitological assessment for the presence of ova of S. haematobium in urine and abdominopelvic ultrasonographic examination for bladder and secondary kidney pathology were carried out. S. haematobium prevalence of 25.68% (66/257) was recorded among the participants. There was a significantly higher prevalence of 69.2% of urinary schistosomiasis in the females than the prevalence of 31.8% in males (P = 0.902). The intensity of infections was mostly light (55) (21.8%) compared to heavy (10) (3.9%) with the mean intensity of 16.7 eggs/10 mL urine. Structural bladder pathology prevalence among participants was 33.9%. The bladder and kidney pathologies observed by ultrasound in subjects with S. haematobium infections included abnormal bladder wall thickness (59%), abnormal bladder shape (15.2%), bladder wall irregularities (15.2%), bladder masses (1.5%), bladder calcification (1.5%), and hydronephrosis (3%). Infection with S. haematobium was associated with bladder pathology. Higher frequencies of bladder abnormalities were observed more in the participants with light intensity of S. haematobium infection than in those with heavy infection. More bladder pathology was also seen in women than in men, although this was not statistically significant. In conclusion, there is evidence that the development of bladder pathology may be associated with S. haematobium infection.

Carotid IMT is more associated with stroke than risk calculators.

BACKGROUND: It is unclear whether a natural marker of atherosclerosis (carotid intima-media thickness: CIMT) or calculated risk score is more associated with stroke. We therefore comparatively examined the relationship between CIMT as well as two cardiovascular risk calculators (Omnibus Risk Score -ORS and Framingham Risk Score- FRS) and the occurrence of stroke among hypertensive African patients. METHODS: CIMT was measured in 555 consecutive consenting hypertensive adults (377 stroke patients and 178 stroke-free subjects). The 10-year cardiovascular risk was calculated for each participant with the FRS and ORS. The strengths of association between FRS, ORS, CIMT, and stroke occurrence were examined using logistic regression. The discriminative capacity of FRS, ORS, and CIMT for stroke occurrence was assessed with c-statistics. RESULTS: Higher average CIMT (OR 11.71; 95% CI 1.65-83.07; P = 0.01) was strongly associated with stroke after adjusting for age, sex, blood pressure, serum cholesterol, and blood sugar. Neither the FRS (OR: 1.03; CI: 0.89-1.19, P = 0.68) nor the ORS (OR: 1.08; CI: 0.90-1.30; P = 0.41) was significantly associated with stroke. CIMT had a higher c-statistic for differentiating stroke patients from hypertensive controls (right: c = 0.63, P < 0.001; left: c = 0.67, P < 0.001; average: c = 0.66, P < 0.001) than some conventional risk factors. Neither FRS (P = 0.39) nor ORS (P = 0.55) was able to independently differentiate between stroke and hypertensive patients. CONCLUSION: CIMT, but neither FRS nor ORS, is independently associated with stroke among Nigerian African hypertensive patients. CIMT may be a better tool for estimating the overall risk of stroke than FRS or ORS in this population.

Can common carotid intima media thickness serve as an indicator of both cardiovascular phenotype and risk among black Africans?

BACKGROUND: It is not known whether common carotid intima media thickness (CIMT) can serve as a surrogate marker of cardiovascular risk among black Africans. Therefore, we examined whether CIMT differed significantly among individuals with distinct cardiovascular phenotype and correlated significantly with traditional cardiovascular risk factors in a black African population. METHODS: CIMT was measured in 456 subjects with three distinct cardiovascular phenotypes - 175 consecutive Nigerian African stroke patients, 161 hypertensive patients without stroke and 120 normotensive non-smoking adults. For each pair of cardiovascular phenotypes, c-statistics were obtained for CIMT and traditional vascular risk factors (including age, gender, weight, waist circumference, smoking, alcohol, systolic and diastolic blood pressures, fasting plasma glucose, fasting total cholesterol). Pearson's correlation coefficients were calculated to quantify bivariate relationships. FINDINGS: Bilaterally, CIMT was significantly different among the three cardiovascular phenotypes (right: p < 0.001, F = 33.8; left: p < 0.001, F = 48.6). CIMT had a higher c-statistic for differentiating stroke versus normotension (c = 0.78 right; 0.82 left, p < 0.001) and hypertension versus normotension (c = 0.65 right; 0.71 left, p < 0.001) than several traditional vascular risk factors. Bilaterally, combining all subjects, CIMT was the only factor that correlated significantly (right: 0.12 ≤ r ≤ 0.41, 0.018 ≤ p < 0.0001; left: 0.18 ≤ r ≤ 0.41, 0.005 ≤ p < 0.0001) to all the traditional cardiovascular risk factors assessed. CONCLUSION: Our findings support CIMT as a significant indicator of both cardiovascular risk and phenotype among adult black Africans. However, specific thresholds need to be defined based on prospective studies.

Head injury: correlation of brain morphology on cranial CT with head injury severity using a new (computed tomography-head injury severity assessment) grading scale--a pilot study.

Eighty two (82) consecutive patients who presented with mechanical brain injury to the Accident and Emergency department of our hospital and were assessed with cranial Computerized Tomographic Scan between November 2005 and April 2006 were included in the study. Demographic data were obtained at admission. Clinical severity of head injury was assessed by the Glasgow Coma Scale Score just before cranial CT while morphologic severity was assessed using features on the same post-resuscitation cranial CTwith which theTCDB (Traumatic Coma Databank) grade and CT-HISAS (computerizedTomographic-Head injury Severity Assessment Scale) score were assessed. Both the TCDB and CT-HISAS scores were correlated with short-term outcomes using the Glasgow outcome score. Pearson's correlation coefficient, ANOVA and regression models were used as appropriate for statistical tests of significance.The age range of Patients was between 3 months and 86 years with a mean of 26.8 years and median of 25.9 years +/- 1.9 years (95% CL). There were more males (74.4%) than females (25.6%). There was a negative correlation between Post resuscitation GCS and CT-HISA score (p = -0.0141). However, although patients with non-functional outcome based on Glasgow Outcome score had higher CT-HISA scores, this relationship was not statistically significant. From our study, brain morphology on cranial CT using the CT-HISA Scale predicts clinical severity and outcome.We believe this study that CT-HISA may find useful application in assessment of teleradiologically transferred CT images of patients as well as research in mechanical brain trauma.

Normal Ultrasonographic Dimensions of the Liver in Neonates in South-West Nigeria.

BACKGROUND: Ultrasound (US) is first choice of imaging in children suspected to have liver pathology because it is cheap, quick to perform with no radiation risks. Liver size may be increased or decreased in many pathological conditions and ultrasound is ideal since clinical evaluation by palpation and/or percussion can be unreliable or inaccurate. OBJECTIVE: To our knowledge, no previous study has been done in an exclusively large neonatal population in Sub-Saharan Africa to establish reference values for the liver size. This study aims to determine by USS, the normal range of longitudinal dimensions for the liver in healthy neonates. METHODS: A prospective cross-sectional study of 508 apparently healthy neonates. Routine clinical examination and liver ultrasound scans were performed before discharge or at the immunization clinic. Liver size was taken as the longitudinal dimension in the mid-clavicular line. Normograms with point-wise 95% reference ranges were constructed using a normal approximation. RESULTS: Mean age was 9.67 ± 7.68 days and 51.4% were males. Ultrasound span of the liver ranged from 3.28-8.02 cm with a mean of 5.72 ± 0.88 cm. There was no evidence for sex difference in the liver size, p= 0.338. The liver size correlated most strongly with neonatal weight (r=0.55) and age (r=0.53) which were used in plotting the 95% reference ranges for the neonatal liver normogram. CONCLUSIONS: This study of a large neonatal population has provided the normal range of US liver dimensions for neonates in the study area, using the age and weight in plotting the 95% reference ranges for the liver normogram.

Ultrasound evaluation of intima-media thickness of carotid arteries in adults with primary hypertension at Ibadan, Nigeria.

BACKGROUND: Ultrasound measured Carotid Intima-Media Thickness (CIMT) is a simple and inexpensive tool for assessing the cumulative effects of hypertension on the carotid arterial walls. It is also an independent predictor of future myocardial infarction and stroke risk. OBJECTIVES: This study compared ultrasound measured CIMT in hypertensive adults with non-smoking normotensive controls. It also documented variations in CIMT with subjects' age and sex. METHODOLOGY: Hypertensives (120) of both sexes aged 18 years and above were recruited from the Hypertension Clinic at University College Hospital (UCH) Ibadan. Normotensive controls (120) were also recruited from the general public. The CIMT was measured on B- mode ultrasound using the technique of 'Multiple Carotid Sites Measurement' RESULTS: Mean CIMT values were 0.756 mm ± 0.130 and 0.751 mm ± 0.129 for the hypertensive group and 0.638 mm ± 0.088 and 0.67 0mm ± 0.107 for the control group on the left and right sides respectively (P=0.000). Higher CIMT values were noted among male hypertensive subjects (P=0.030). CIMT values also showed positive correlation with subjects' age. CONCLUSION: There was a significant difference in CIMT for hypertensives when compared with normotensives in the study area. CIMT also varies with subjects' age and sex.

Ultrasound prevalence of gallstone disease in diabetic patients at Ibadan, Nigeria.

BACKGROUND: Gallstones (GS) in the gallbladder (GB) can be responsible for a whole spectrum of disease entities which may lead to a surgical emergency with high mortality. Diabetes mellitus (DM) is a debilitating disease that affects all systems in the body, and literature documents a higher incidence of gallstone disease (GSD) and its complications in diabetics than in the non-diabetic population. Most local studies on the association between GS formation and DM have focused on type 2 diabetics. This study was therefore designed to determine the prevalence of GS in both type 1 and type 2 DM and elucidate the demographic and social factors associated with formation of GS in diabetic patients. MATERIALS AND METHODS: Four hundred diabetic patients aged between 15 and 82 years had abdominal ultrasound to diagnose or exclude the presence of GS. RESULTS: GS was found in 70 (17.5%) of the 400 patients. Positive cases had a male to female ratio of 3:4 and 59 (51.92%) were above the age of 40 years with type 2 DM. Body mass index (BMI) greater than 25 kg/m 2 was seen in 56 (48.3%) patients; smoking and alcohol intake were insignificantly implicated. Jaundice was recorded in 8 (11.4%) while abdominal pain was in 24 (34.3%) patients, and 52 (74.3%) patients of those with GSD had had diabetes for more than 4 years. CONCLUSION: GSD in DM is influenced significantly by age, BMI, and duration of the disease, while gender, social factors, and parity do not influence as strong associated factors.

Ultrasound prevalence and characteristics of incidental thyroid lesions in Nigerian adults.

AIM/OBJECTIVE: Thyroid lesions are common and range from the incidental, asymptomatic, small solitary nodule to the large and partly intrathoracic masses. Thyroid lesions that are not palpable but identified by radiological imaging for unrelated symptoms are defined as incidentalomas of the thyroid gland. OBJECTIVE: The aim of this study was to determine the ultrasound prevalence of thyroid incidentalomas and describe the ultrasound characteristics of such detected incidentalomas in Nigerian adults. METHODS: This was a prospective study that examined 340 subjects over a period of 6 months. They were selected randomly from volunteers and patients presenting for ultrasound examination of other parts of the body. The subjects had their necks examined by palpation and ultrasound in the department of Radiology, University College Hospital, Ibadan, using a General Electric LogicP5 ultrasound machine with a 6-10 MHz linear transducer. Any incidentaloma detected was classified using the 'Thyroid Imaging Reporting and Data System' (TIRADS) classification. RESULTS: Three hundred and forty (340) subjects comprising of 153 males and 187 females were examined. The ultrasound prevalence of thyroid incidentalomas was 22.4%. Thyroid incidentalomas were more common in females than males but this was not statistically significant. The prevalence of thyroid incidentaloma significantly increased with age up to the seventh decade. Majority of the lesions were solitary, homogenous and cystic. CONCLUSION: The ultrasound prevalence of thyroid incidentalomas documented in the study area is high (22.4%) and they were commoner in women and older subjects. Majority of the lesions, 41 (53.95%) were classified as TIRADS 2 (benign lesions).

Risk factors for stroke among patients with hypertension: a case-control study.

BACKGROUND: In some African countries, more than half of the adult population are estimated to be hypertensive leading to an escalated burden of stroke in the continent. We conducted the first study to unravel the major risk factors for stroke among hypertensive patients (Nigerian-Africans) using a case-control design while also exploring the relative contributions of carotid intima medial thickness (CIMT) and carotid diameter as risk markers for stroke. METHODS: Using conventional techniques, stroke-related demographic, clinical and laboratory data were obtained from 135 consecutive volunteering hypertensive stroke patients and compared with 117 age and gender-matched hypertensive patients with no clinical evidence of stroke, TIA or coronary artery disease. Common carotid IMT and diameters were measured in all participants. Univariate and multivariate analyses were conducted at p=0.05. RESULTS: 13.2% of the stroke patients were first diagnosed as hypertensive at presentation with stroke. Among hypertensive patients, the modifiable factors significantly (p<0.00001 to p<0.037) associated with stroke occurrence included higher maximum and minimum blood pressures in the preceding 3months, higher fasting plasma glucose, greater alcohol consumption, lesser physical activity and increased CIMT. Using a multivariate model which predicted 84.6% of stroke occurrence, only fasting total cholesterol of >150mg/dl (p=0.021) and common carotid diameter of ≥5.9mm (p=0.008) independently multiplied the risk of stroke. CONCLUSIONS: Particularly in resource-limited settings, aside from BP control, stroke prevention efforts should be targeted towards these identified risk factors for stroke among hypertensive patients. Carotid diameter should be further explored as an intermediate risk marker for stroke.

Ultrasound Prevalence of Gallstone Disease in Diabetic Patients at Ibadan; Nigeria

Background: Gallstones (GS) in the gallbladder (GB) can be responsible for a whole spectrum of disease entities which may lead to a surgical emergency with high mortality. Diabetes mellitus (DM) is a debilitating disease that affects all systems in the body; and literature documents a higher incidence of gallstone disease (GSD) and its complications in diabetics than in the non-diabetic population. Most local studies on the association between GS formation and DM have focused on type 2 diabetics. This study was therefore designed to determine the prevalence of GS in both type 1 and type 2 DM and elucidate the demographic and social factors associated with formation of GS in diabetic patients. Materials and Methods: Four hundred diabetic patients aged between 15 and 82 years had abdominal ultrasound to diagnose or exclude the presence of GS. Results: GS was found in 70 (17.5) of the 400 patients. Positive cases had a male to female ratio of 3:4 and 59 (51.92) were above the age of 40 years with type 2 DM. Body mass index (BMI) greater than 25 kg/m 2 was seen in 56 (48.3) patients; smoking and alcohol intake were insignificantly implicated. Jaundice was recorded in 8 (11.4) while abdominal pain was in 24 (34.3) patients; and 52 (74.3) patients of those with GSD had had diabetes for more than 4 years. Conclusion: GSD in DM is influenced significantly by age; BMI; and duration of the disease; while gender; social factors; and parity do not influence as strong associated factors

Complications of chronic sinusitis on orbital sonography and craniofacial computed tomography--a case report.

A 15-year-old boy without a previous history of sinusitis presented with life threatening complications from chronic pansinusitis. This report highlights the role of ultrasound and computed tomography (CT) in the diagnosis and management of occult sinusitis and its complications.

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.

Myelographic abnormalities of spinal cord and nerve roots lesions in conventional myelography.

The authors review the myelographic abnormalities of spinal lesions on 90 patients evaluated with conventional or fluoroscopy myelography between 1989 and 1995. The value of Conventional myelography in spinal lesions involving the spinal cord and nerve roots are assessed. The subjects include 49 (45.4%) males and 41 (45.6%) females with a mean age of 38.3 years. Majority of the cases 74(82.2%) had specific neurological symptoms while 16 (17.8%) presented with non-specific neurological symptoms. On the whole 78 (86.7%) cases were successfully analysed, in which 58 (74%) cases had abnormal myelograms and 20 (25.5%) had normal myelograms. Extradural lesions was seen in 47 (81%) cases, while 6 (10.3%) cases and 2 (3.5%) cases showed Intramedullary and Intradural-extramedullary lesions respectively. 3 (5.2%) cases showed combined lesions. The most common anatomical site or location of abnormal myelograms was the Thoracic region with 31 (53.4%) cases, 16 (27.6%) cases in the lumbar, 10 (17.2%)and 1 (1.8%) cases in the cervical and sacral regions respectively. Conventional myelography can be successfully used to demonstrate myelographic abnormalities, including identification and determination of the extent of the anatomical location of spinal lesions.

Assessment of diaphragmatic levels on plain chest radiograph--a new approach.

BACKGROUND: The aim of this study was to provide an alternate simple linear measurement of diaphragmatic levels from a relatively fixed position, the lung apex, on chest radiographs. STUDY DESIGN: 526 consecutive posteroanterior (PA) chest radiographs of Nigerian adult subjects reported as normal were evaluated. The 'Lung apex to diaphragmatic apex' (LATDA) distances in centimeters for both hemidiaphragms were obtained from the chest radiographs. RESULTS: There were 210 males and 316 females ranging in age from 15 to 85 years. The mean ranges of LATDA values on the right were 21.2 cm to 23.8 cm and 20.8 cm to 22.7 cm, with total means of 22.9 cm and 21.5 cm in males and females respectively. On the left, the ranges were 23.1cm to 25.5 cm and 21.6 cm to 23.5 cm with total means of 24.4 cm and 22.6 cm in males and females respectively. Left LATDA was higher in 95% of subjects and higher LATDA values represent lower hemidiaphragms while low LATDA values indicate elevated hemidiaphragms. LATDA measurements were statistically higher in males for all age groups. Mean differences between right and left LATDA were 1.5 cm and 1.2 cm in males and females respectively. CONCLUSION: From this study, the lower limits of normal LATDA values in females and males are 16 cm and 18 cm while upper limits are 28 cm and 30 cm respectively. A "rule of twos" that could be applied to routine use in clinical practice is suggested thus: Left LATDA value is 2 cm higher than right LATDA value and LATDA values in males are 2 cm higher than in females.

Ultrasonographic assessment of fetal gender.

The purpose of this study is to evaluate the value and accuracy of ultrasonography in the detection and determination of the gender of the fetus. This prospective study involves the Ultrasound examination of a total of 415 fetuses including 216 (52%) females and 199 (48%) males. The mean gestational age at which the fetuses were scanned was 32 weeks 1 day, with a range of 15 to 40 weeks. Fetal sex identification was only possible in 363 (87.5%) cases. Of these, the fetal sex corroborated birth sex in 314 (75.7%) and disagrees in 49(11.8%) cases. The overall estimated sensitivity of the scan in fetal sex determination is 86.5%, while the estimated specificity for identification of the female sex (90.6%) was higher than that of the male (83.2%). Despite the high efficacy of ultrasound in sex determination obtained in our study, the errors and failure rates should be made known to mothers who are willing to know the gender of their fetuses.

Chronic dehydration and symptomatic upper urinary tract stones in young adults in Ibadan, Nigeria.

INTRODUCTION: Upper urinary tract stones are relatively uncommon in Nigeria and they are most often seen in men in their 4th and 5th decades. There is however no recent report on this disease from our locality. This retrospective study was done to evaluate the pattern of presentation of upper tract urolithiasis in our institution. PATIENTS AND METHODS: We reviewed all cases of renal stones referred to a single Consultant in a Teaching Hospital in Southwestern Nigeria over a two year period. RESULTS: Twenty cases of renal calculi presented within the study period. All patients presented with sudden onset of loin or back pain, and the diagnosis was confirmed radiologically. The mean age of our patients was 27 years (age range 13-38 years), and the male to female ratio was 1.5: 1. Nineteen patients (95%) reported poor fluid intake (<1.5L/day), and 17/20 (85%) frequently total fasted totally (no water or food intake) for religious reasons. Serum calcium was normal in 15 of 16 patients (94%) and only marginally raised in the remaining patient. All patients were treated with a high fluid intake (3L/day) and analgesics, and 16 of the patients (80%) passed their stones spontaneously. The other four are currently pain free, one of whom is awaiting surgery. CONCLUSION: This (uncommon) occurrence of upper tract urolithiasis in young adults in Ibadan may be related to chronic dehydration exacerbated by religious fasting. Further studies are required to explore this relationship,