Sonographic evaluation of ocular trauma in Ilorin, Nigeria.

UNLABELLED: PURPOSE.: Ultrasound (US) evaluation of the eye and orbit has become an essential component of clinical ophthalmology. Requests for its use are frequent in the authors' hospital in spite of the absence of a dedicated eye scanner. The extent to which this has influenced the authors' patient management, especially for those with orbito-ocular trauma, informed the decision to carry out this study. METHODS: A retrospective review of cases of orbito-ocular trauma with media opacities and/or intraocular hemorrhage sent for ultrasonography over a 5-year period (January 1997-December 2001) at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, was carried out. The sonographic diagnosis was reviewed with the management outcomes as found in the patients' records. RESULTS: A total of 71 patients (45 male, 26 female) were included in the study (M:F=1:1.7). The minimum age was 1 1 /2 years and maximum was 70 years. The 11- to 20-year age group was mostly affected by trauma (31%). Retinal detachment (22.5%) was the most common posterior segment lesion diagnosed, followed by vitreous hemorrhage (18.3%) and hyphema (11.3%). Visual acuity improved to between 6/9 and 6/18 in 23 (41.4%) of the 56 injured eyes. CONCLUSIONS: The usefulness of orbito-ocular ultrasonography in ophthalmic trauma management has been demonstrated in this study, especially using nondedicated eye scanners when a dedicated one is unavailable.

Sonographic diagnosis of congenital brain malformations: the Ilorin experience.

A retrospective study was done to determine the incidence of congenital malformation of the brain among African infants over a 5 year period. Transfontanelle ultrasound (US) was performed on 98 infants consisting of 45 males and 53 females. The mean age was 2.6 months (range 1-11 months). Congenital malformation was present in 25.5% of the 98 cases studied, most of which were associated with hydrocephalus. Cerebral aqueduct stenosis was the commonest congenital anomaly encountered and was found in 24% of case. This study shows that transfontanelle US is a useful tool for diagnosis of congenital brain malformations in infants.

Recurrent bilateral fronto-ethmoidal mucocoele with intracranial extension: a case report.

Mucocoeles of the paranasal sinuses are relatively uncommon and rarely bilateral, the frontal and ethmoidal sinuses being most commonly affected. Rarely, fronto-ethmoidal mucocoeles expand and extend into the anterior cranial fossa producing mass effect. We report a 66-year-old woman, who presented with a 20-year history of recurrent bilateral progressive proptosis and supra orbital swellings with blindness in the left eye. Ultrasound scan of the left eye showed a large cystic mass in the orbit due to extension of ipsilateral frontal mucocoele. Computed tomographic brain scan showed large bilateral fronto-ethmoidal mucocoeles, erosion of the right orbital roof, right posterior and left anterior sinus walls, and extension of the right frontal sinus into the anterior cranial fossa with mass effect. The patient had a bicoronal craniotomy and bilateral fronto-ethmoidectomy with direct drainage of independent right mucocoele and left mucopyocoele. This case illustrates complications that may result from chronicity and treatment failure in patients with sinus mucocoeles.

Transfontanelle ultrasonography: an invaluable tool in the assessment of the infant brain.

Transfontanelle (cranial) ultrasonography was carried out in 98 Nigerian infants over a period of 5 years. Of the infants, 38 (38.8%) had hydrocephalus from various causes while 26 (25.5%) had congenital anomalies. As ultrasound equipment is becoming a more readily available and affordable tool in the developing countries, it should become much easier for medical staff in these countries to arrive at the correct diagnosis of intracranial diseases in infants.

Intraventricular haemorrhage and periventricular leukomalacia in Nigerian infants of very low birth weight.

Transfontanelle ultrasound scans were performed on 93 very low birth weight neonates admitted at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, between January 1992 and April 1994, to ascertain the pattern and determinants of intraventricular haemorrhage and periventricular leukomalacia. Forty-seven percent of the infants had normal ultrasound; 22% had mild intraventricular haemorrhage (IVH), 7.5% had moderate to severe IVH and 23% had periventricular leukomalacia (PVL) and a 3.5 fold increase in IVH. Infants with apgar scores < or = 3 at 5 minutes had a 6-fold increase in IVH and 2-fold increase in PVL. There was no association with birth weight, gestational age, respiratory distress and place of delivery. Our study suggests that antepartum events proximate to delivery and the immediate post partum events play significant roles in the development of IVH and PVL in this population. Improvement in antenatal, labour and delivery, and immediate newborn care; including provision of basic resuscitation equipment and skills to midwives in the rural maternity centers will reduce the incidence and severity of IVH and PVL.

Comparison of colour Doppler ultrasound and digital subtraction angiography in the diagnosis of lower limb arterial disease.

A fifteen-month retrospective review (December 1993 to February 1995 inclusive) was performed comparing findings at Colour Doppler Ultrasound (CDU) and Digital Subtraction Angiography (DSA) in patients with symptomatic peripheral arterial disease or post-operative by-pass grafts. The records of 63 patients (43 males and 20 females) who had undergone both CDU and DSA within three months of each other were analysed. The age range of case studied was 33-84 years (mean 64 yrs.) Disease in each arterial or graft segment was classified into five grades, 0 (normal) to 4 (complete occlusion). A total of 72 limbs were examined. Fifty-four patients had unilateral symptoms while both limbs are affected in 9 cases. In all 241 arterial and graft segments were studied. There was overall agreement between findings of CDU and DSA in 193/241 (80/1%) and non-agreement in 48/241 (19.9%). Of the 48 examinations that showed discrepancy, the findings in 26/48 (54.2%) were one grade apart while in the remaining 22/48 (45.8%) there was a difference of two or more grades. Agreement between CDU and DSA in the individual arterial segments studied was as follows: common femoral 42/48 (87.5%); profunda femoris 19/25 (76.0%); superficial femoral 27/39 (81.0%); anterior tibial 17/81 (94.4%) and peroneal 15/17 (88/2%). In the grafts, there was an agreement of 20/27 (74/1%) between CDU and DSA. These results show a good correlation between the two imaging modalities with complete agreement and agreement within one grade in 80.1% and 90.9% of cases, respectively, confirming that CDU can be employed as a useful screening technique for assessment of symptomatic patients, allowing selection of patients for angioplasty alone or angiography for arterial mapping or those who require by-pass graft surgery.

Sonographic diagnosis of intracranial hemorrhage and periventricular leukomalacia in premature African neonates.

Transfontanelle ultrasound (US) was done prospectively and analyzed for intra-cranial hemorrhage (ICH) and periventricular leukomalacia (PVL) in 110 premature infants. The babies were divided into two subgroups according to their birth weights (BW): those with BW of 1500 g or less (n = 93) belonged to subgroup A while babies of BW between 1500 and 2500 g (n = 17) were placed in subgroup B. Overall incidence of ICH and PVL was 24.5 and 26.4%, respectively in the 110 cases studied. Under subgroup A, 26/93 (28.0%) cases had ICH while 22/93 (23.7%) cases had PVL. In subgroup B, 2/17 (11.8%) cases had ICH while PVL was noted in 7/17 (41.2%) cases. These results show that premature African children have a lower incidence of ICH but a higher incidence of PVL compared to babies from temperate regions. Genetic and environmental factors are probably responsible for these variations in the occurrence of both diseases in population groups from different geographical locations.

Ultrasound determination of foetal gender: accuracy and social implications.

Seventy six pregnant women were examined by ultrasound (US) for prenatal determination of foetal gender. Results were compared with those of outcome at delivery. The range of gestational age (GA) at scan was 22-40 weeks (mean 35 +/- 4.0 weeks). Forty seven of the babies at birth were boys, while twenty nine were girls. Incorrect prediction foetal gender occurred in four out of seventy-six (5.3%) comprising two males and two females giving an overall accuracy of seventy two out of seventy six (94.7%). Accuracy of gender assignment was forty five out of forty seven (95.7%) for boys and twenty seven out of twenty nine (93.1%) for girls. It is recommended that discretion should be exercised in disclosing the gender of an unborn baby, especially if it does not correspond to the preferred sex of the mother. Determination of foetal gender should not be performed on demand or as a matter of routine in developing countries because of limited resources and shortage of skilled manpower.

Incidence of Armillifer armillatus (pentastome) calcification in the abdomen.

Analysis of plain abdominal radiographs in 214 patients showed Armillier armillatus calcification in three cases (1.4 pc). Two of these cases were males aged 50 and 70 years respectively. The only female with pentastome calcification was aged 35 years giving a male to female ratio of 2:1. Typically the calcifications were either comma-shaped or rounded with central lucency measuring about 5 mm in diameter. Two (66.7 pc) of the three patients who were positive for parasitic calcification complained of abdominal pain. This however, does not necessarily imply a causal relationship between pentastome infestation and abdominal discomfort.

Serum electrolyte and protein changes after intravenous injection of sodium and meglumine diatrizoate (urograffin-370).

Serum electrolyte and protein changes in 35 Nigerian patients undergoing intravenous urography were evaluated after injection of 60 mls sodium and meglumine diatrizoate (Urograffin-370). Statistically, significant changes were noted in the values of serum calcium, proteins and albumin at 5 and 30 minutes after the injection (P < 0.005). The mean percentage decreases noted were calcium 13%, protein 17% and albumin 13%. At 30 minutes post-injection, the serum protein and albumin levels had incompletely recovered while calcium values continued to decrease. Non-statistically, significant changes were observed in the values of serum sodium, potassium and phosphate at 5 and 30 minutes respectively following contrast medium injection. Alterations in the levels of serum electrolytes especially calcium are most probably responsible for such adverse effects as convulsions and cardiac arrhythmias.

Prediction of birthweight by fetal ultrasound biometry.

A total of 104 women with singleton pregnancies who were delivered between 37 and 42 weeks gestation had ultrasound scans during the fortnight before delivery. The biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were measured in all cases. Estimation of fetal weight (EFW) was done by four different methods: using AC alone, AC/BPD, AC/FL and AC/BPD/FL. Results were compared with values of actual birthweights at delivery. There was no significant difference between the mean birthweights of the 47 boy and 57 girl fetuses studied. The EFW(Shepard) method showed the least bias overall: mean percentage error 1.7%, standard deviation (SD) 10.6%. The other three methods significantly underestimated birthweights on average: EFW(Deter), mean error 2.2%, SD 9.3%, p < 0.02; EFW(Campbell), mean error 5.4%, SD 9.5%, p < 0.001; EFW(Hadlock), mean error 5.6%, SD 9.3%, p < 0.001. The percentage error in each group was significantly negatively correlated (p < 0.001) with the scan-delivery interval. Two new equations were generated which gave more accurate predictions for the cases under study using AC, BPD and FL as a combination and also in addition to scan-delivery interval (SDI) in days.

Vicarious excretion of intravenous diatrizoate (Urograffin) in renal insufficiency: report of two cases.

Two cases of hepato-biliary excretion of intravenous sodium and meglumine diatrizoate (Urograffin 76%) are presented. One of these patients showed specification of of the gallbladder and colon while in the other case only the gallbladder was specified. In both cases there was marked deterioration of renal function. A brief review of the literature on hepatobiliary excretion of intravenous sodium and meglumine diatrizoate is given.

Sonographic assessment of the incompetent cervix in pregnancy.

Ultrasonography (US) was done in 40 women with a history of recurrent midtrimester abortion. The results were compared with those of a control group who consisted of 53 women with no previous history of abortion and had had at least one full term pregnancy with normal vaginal delivery. Mean internal cervical os diameters of 16.0 mm and 22.5 mm at 10 and 27 weeks gestation respectively were recorded in the cervical incompetent patients while mean values of 7.7 mm and 14.5 mm at 13 and 28 weeks gestation were observed in the normal control subjects. Full analysis of covariance showed statistically significant difference in the internal os diameter between the control group and the cervical incompetence cases (t90 = 9.33, P less than 0.001).

Value of ultrasonic placental localization in pregnancy after caesarean section.

Ninety-four women who had undergone previous lower segment caesarean section (CS) were evaluated in the third trimester of pregnancy using ultrasound for localization of the placenta. Results obtained showed that posterior upper uterine segment placental implantation occurred with the highest frequency of 36.2pc followed by anterior upper uterine segment and fundal implantations which each had a frequency of 19.1pc. For anterior lower segment implantation the frequency was 18.1pc while placenta praevia occurred with frequency of 5.3pc. Altogether, anterior uterine wall placental implantation occurred with combined frequency of 37.2pc and justifies routine ultrasonic placentography in pregnant women with previous CS who are being considered for surgical procedures like amniocentesis or another CS.

Pancreatic calcification in diabetes mellitus at Ilorin, Nigeria.

Plain abdominal radiograph showed pancreatic calcification in four cases (5.2%) in a total of 77 cases of diabetes mellitus. All patients with calcified pancreas were insulin-dependent male diabetics. No direct relationship was observed between duration of illness and presence of calcification in the pancreas. Low incidence of pancreatic calcification among diabetics in recent reports from Nigeria probably suggests a changing pattern of the disease in the tropics.

The "string-sign" in sonographic diagnosis of diamniotic twin pregnancy.

A consistent echogenic line, the "String-sign" resulting from opposed amniotic membranes in diamniotic twin pregnancy as seen at sonography is reported. The string sign is especially useful in the detection of unsuspected twinning in late pregnancy and it should be taken as a definite pointer to multiple pregnancy whenever its presence is established at any stage in pregnancy.

Familial subluxation of the metacarpophalangeal and proximal interphalangeal joints of the little finger in two consecutive siblings: the "serpentine little finger".

Two consecutive siblings, both males, presented with congenital curly little finger ('serpentine finger') caused by subluxations at the metacarpo-phalangeal and the proximal interphalangeal joints. Literature on this phenomenon is scant, and to the best of the authors' knowledge it is probably a new entity. A theory of the possible aetiology is presented.

Intravenous urographic findings in Burkitt's lymphoma.

Intravenous urography was performed in 13 patients with Burkitt's lymphoma and showed that 4 cases had bilateral diffuse renal lymphomatous deposits. Back pressure changes due to ureteric compression by abdominal or pelvic masses was recorded in 5 cases and lateral displacement of the ureter in 3 cases. One patient showed bilateral poor excretion of contrast medium while 2 cases had extrinsic impressions on the urinary bladder. Intravenous urography was helpful in determining the extent of urinary tract involvement in Burkitt's lymphoma and serves as an important diagnostic tool in the investigation of patients with urinary tract symptoms or signs in this disease.

Sonographic pattern of gallbladder disease in children with sickle cell anaemia.

A prospective analysis of ultrasound examinations of the gallbladder in 161 children with sickle cell anaemia revealed cholelithiasis in 7 cases (4.2%). Biliary sludge was present in 12 cases (7.5%). The commonest abnormality noted was gallbladder wall thickening seen in 13 patients (8.1%). The age range of patients studied was 2 1/2 months to 16 years with a mean of 7.96 years. The youngest age for development of cholelithiasis was 10 years while biliary sludge was noted earliest at 5 years. Gallbladder wall thickening appeared as early as 4 years. Dietary and environmental factors are probably responsible for the low incidence of cholelithiasis in Africans with sickle cell anaemia. The low incidence of cholelithiasis in the African child with this disease does not justify routine and follow-up ultrasound scans in all cases with sickle cell anaemia.