A Comparative Study of Uterine Artery Doppler Parameters and Endometrial Characteristics in Women with Unexplained Infertility and Fertile Women at a Nigerian Teaching Hospital

OBJECTIVES

To investigate the uterine artery Doppler parameters and endometrial characteristics in women with unexplained infertility.

METHODS

A prospective case-control study of 42 women with unexplained infertility and 42 fertile controls. Their mid-luteal phase transvaginal Doppler parameters of both uterine arteries and endometrial characteristics (endometrial blood flow, thickness and volume) were investigated and analysed. P values < 0.05 was statistically significant.

RESULTS

The mean uterine artery pulsatility index (PI) and resistivity index (RI) of the cases (women with unexplained infertility) were significantly higher compared to the values in the fertile controls (PI = 2.81±0.61 vs 2.15±0.65; p=0.001) (RI= 0.87±0.08 vs 0.82±0.07; p=0.003). In addition, the end-diastolic volume (EDV) (6.12±4.17 vs 9.37±5.14; p=0.007) and endometrial-subendometrial blood flow (p=0.036) were significantly lower in the cases compared to the controls. Multivariate logistics analysis showed that PI was independently associated with infertile status (p=0.006). There was no significant difference in the mean PSV (48.69±10.9 vs 50.58±11.30; p=0.602), endometrial thickness (10.30+3.13 vs 10.72+3.10; p=0.544), endometrial volume (7.82+1.56 vs 8.23+1.71; p=0.323), mean age (32.28±4.062 vs 31.91±3.58 years; p=0.502), body mass index (26.15±2.71kg/m2 vs 25.24±2.85 kg/m2; p=0.18) menstrual bleeding days (4.07±0.89 days vs 4.02±0.95 days; p=0.481) duration of menstrual cycle (28.02±1.09 days vs 27.64±1.36 days; p= 0.162), smoking history (p=0.909) and alcohol intake (p=0.507) of the infertile women compared with the fertile controls, respectively.

CONCLUSION

Women with unexplained infertility have increased uterine artery Doppler PI and RI and reduced endometrial-subendometrial perfusion compared with fertile controls.

Diagnostic accuracy of tru-cut biopsy of breast lumps at University College Hospital, Ibadan

BACKGROUND

Tru-cut needle biopsies form an integral part of Triple assessment of breast cancer and include clinical assessment, mammography and core needle biopsy. No study has been done to evaluate the validity of the procedure in our environment. This study was done to evaluate the validity of core needle biopsies in our centre.

METHOD

A retrospective study of patients with tru-cut needle biopsies of breast lumps and follow-up excisional biopsy or mastectomy done in the Department of Surgery, University College Hospital, Ibadan over a ten year period was done. Fifty one patients who fulfilled the inclusion criteria had their records obtained from the Department of Pathology. The diagnosis was classified into benign and malignant with the excisional biopsy or mastectomy diagnosis used as the gold standard. The sensitivity, specificity and accuracy were calculated and kappa was also done to evaluate the degree of agreement.

RESULTS

A total of 51 cases were included in this study. The average age of the patients was 47 ± 13 years with a range from 19 to 81 years. Thirty of the biopsies (59%) had a definitive diagnosis of malignancy while twenty one (41%) were benign. The overall sensitivity, specificity and accuracy were 86%, 71% and 80.4% respectively. The specificity of malignant biopsies was 68% while benign was 35%. The level of agreement for malignant biopsies was higher than benign biopsies with a kappa of 0.39 for malignant diagnosis as against 0.29 for benign.

CONCLUSION

Tru-cut needle biopsies have a comparable sensitivity and specificity to excisional biopsies. Diagnostic accuracy can be further enhanced with the adoption of image guided biopsies.

Mammographic breast pattern in Nigerian women in Ibadan, Nigeria

INTRODUCTION

Mammographic breast density is dependent on the relative proportion of radiolucent fat and radio-dense connective and glandular tissue. This breast density is said to be a marker of risk for breast cancer and has received widespread interest in many countries in recent years.

AIMS AND OBJECTIVES

The main objective of this study is to estimate the prevalence of the various mammographic breast density patterns and seeks to find any association between the reported breast patterns and various demographic variables in women in Ibadan, South West Nigeria.

METHODS

A prospective descriptive study of mammographic breast pattern in 498 women at the Department of Radiology, University College Hospital Ibadan. Two screening views and additional views when necessary were done on each breast with the Senographe DMR+ Mammographic Unit. Participants also completed an assisted administered questionnaire which was used to obtain data on their socio-demographic characteristics.

RESULTS

The study confirmed significant association with age and parity as in previous reports in the diaspora.

CONCLUSION

The study confirmed denser mammographic breast pattern in younger and nulliparous women. Future work on mammographic density and other variables is contemplated for complete cancer related data in our peculiar setting.

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.

Experience with three-dimensional computed tomographic angiography in Ibadan, Nigeria

INTRODUCTION

The latest versions of spiral CT scanners have provided the radiologist with unparalleled capabilities for vascular imaging. Computed Tomographic Angiography (CTA) has the potential of revolutionizing vascular imaging and with evolving improvements may replace conventional angiography in the near future

OBJECTIVE

To report our initial experience with CTA in Nigeria; highlighting its usefulness as a non invasive modality and its clinical applications in diagnosis of vascular abnormalities of various parts of the body.

MATERIALS AND METHODS

We reviewed 62 patients who had CTA between December 2003 and September 2005.. The studies were performed using a spiral technique with GE CT/e single-slice scanner (General Electric Medical Systems) having a gantry rotation period of one second. Details of techniques of data acquisition, methods of 3-D reconstruction and clinical applications are discussed.

RESULTS

Vascular abnormalities were demonstrated in 26 (42%) patients including 5 cranial arteriovenous malformations (AVMs), 3 intracranial aneurysms, 1 spinal AVM, 3 aortic aneurysms, 5 carotid artery stenosis, and 2 traumatic peripheral aneurysms.

CONCLUSION

Correlations between CTA and surgical findings were good. CT angiography has enhanced our practice of vascular radiology in Ibadan as it has done in the west and other parts of the world.

Superior vena cava obstruction: diagnosis, management and outcome

OBJECTIVE

To document our experience with superior vena cava obstruction in a black African population.

DESIGN

A retrospective study of clinical data collected from cancer registry, patients case noted, cardiothoracic surgical unit's and operating records between June 1975 and May 1999.

SETTING

University College Hospital, Ibadan, Nigeria which hosts a major cancer centre in the West African sub-region and also serves community clinics.

PATIENTS

All patients with superior vena cava (SVC) obstruction referred for evaluation and treatment.

MAIN OUTCOME MEASURES

Patients who had clinical features related to SVC obstruction and full investigation including tissue diagnosis were collated. Methods of treatment of acute episodes, definitive treatment and outcome of SVC obstruction were studied.

RESULTS

One hundred and twenty nine consecutive patients with SVC obstruction were treated. There were 100 males and 29 females. Mean age was 36 +/- 15 years. The annual incidence increased from 2.3 patients per year during the first 12 years to 8.4 patients per year during the second 12 years. The most common symptoms were swelling of face, arms and chest-wall (87.6%) with associated venous congestion over these areas. Majority of the patients (73.8%) presented within 1 to 12 months of onsets of symptoms. Patients with benign diseases had longer duration of symptoms before presentation (mean 3 months) than those with malignant disease (mean 6 months). Majority of the patients (82.2%) had malignancy as the underlying cause of the SVC obstruction and 47.2% of the malignancy was bronchogenic carcinoma. Symptomatic relief and outcome was best in benign disease (7 out of 8 patients, 87.5%). Lymphomas had better outcome than bronchogenic carcinoma among the patients with malignant diseases.

CONCLUSION

Patients with SVC obstruction should be carefully evaluated before treatment. This will enhance application of specific therapy.

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.

Cranial computed tomographic (CT) findings in HIV-positive Nigerian patients presenting for neurosurgical evaluation

INTRODUCTION

The central nervous system (CNS) is an important site of HIV infection. As many as one quarter of AIDS patients present with neurological symptoms and up to 75% of the patients may have CNS abnormalities at autopsy. Under these circumstances therefore, differential diagnoses in HIV-positive patients with neurological symptoms constitute a management challenge.

OBJECTIVE

To describe the pattern of cranial computed tomographic (CT) findings in neurosurgical patients with HIV infection.

STUDY DESIGN

Retrospective analysis.

PATIENTS AND METHOD

A total of 1907 patients were admitted from October 1996 to October 2001. Sixteen patients were positive for HIV using the Western blot. We reviewed their biodata, clinical features and cranial CT findings.

RESULTS

There were 10 male and 6 female patients. Twelve patients had cranial CT. Four patients had lesions that could be attributed to direct infection by HIV virus. Two patients had lesions that suggested immunosuppression from HIV infection. Diffuse breakdown in blood brain barrier (BBB) with contrast enhancement as well as mass effect that was disproportional to the enhancing lesion were common findings in three patients. The other lesions seen on cranial CT could not be directly linked to HIV infection.

CONCLUSION

Apart from the diffuse breakdown in blood brain barrier with disproportional mass effect, our findings were similar to previous reports. Further study with a larger population of patients and, especially, biopsy of the CNS lesion will be needed to confirm our findings.

Solitary intracranial tuberculoma in patients without immuno-suppression: a report of three cases

BACKGROUND AND OBJECTIVE

Poverty, drug resistance and the advent of human immunodeficiency virus infection (HIV) have led to a recent upsurge in the incidence of tuberculosis including intracranial tuberculosis. In this article, we report 3 patients who had solitary brain tuberculomas and were otherwise healthy to underscore the importance of continuing vigilance for this disease.

CASE REPORTS

Three patients (57 years, female; 52 years, male; 7 years male) presented to our unit with features of intracranial tumours. They were all HIV negative with no previous history of tuberculosis. Cranial computed tomography scans demonstrated uniformly contrast enhancing falcine supratentorial masses in the adult patients and a cerebellar hemispheric lesion with peripheral contrast enhancement in the paediatric patient

INTERVENTION

All the patients had gross total tumour excision. The histology confirmed a tuberculoma. They all had antituberculous therapy after histological confirmation. The outcome was good in all the patients.

CONCLUSION

Intracranial tuberculoma can occur in otherwise healthy individuals and should always be considered in the differential diagnosis of solitary intracranial mass lesions in sub-Saharan Africans so that minimally invasive procedures can be used to establish the correct diagnosis.

Computed tomographic pattern of stroke in children with sickle cell anaemia in Ibadan

We present the findings in 14 paediatrics patients with SCA who had CT examination at the University College Hospital Ibadan on account of stroke between 1993 and 2000. There were 8 female and 6 male with a mean age of 11.25 years and SD of 3.66. Cerebral infarction was the most common finding occurring in 57% of the patients while intracerebral bleed was seen in 21%. Two patients had a mixed lesion and atrophy was seen in one patient. Five patients (36%) had their lesion on the right hemisphere while eight (57%) had their lesions on the left side. The frontal and parietal lobes were mainly affected. Prompt CT screening of the brain in a child with sickle cell anaemia who presents with symptoms and signs suggestive of stroke can help identify the particular type of lesion and this may influence mode of therapy given as well as prognosis

Computerised tomographic detection of intracranial complications of paranasal sinus infections

Ninety-four patients were referred for CT examination of the paranasal sinuses within a five year period. Only 11 (11.7%) of them had intracranial complications. These include cerebral, subdural and epidural abscesses, frontal bone osteomyelitis. The maxillary and ethmoidal sinuses were mostly involved and can be implicated as the sinogenic causes of intracranial infections. Sphenoidal sinus was not involved in any of the patients.

Computed tomographic evaluation of TB spine in Ibadan

BACKGROUND

Tuberculosis still remains a major problem in the developing countries. The involvement of the spine is also of increasing importance, because of the resurgence of TB in association with AIDS. This paper is designed to evaluate the applicability of CT in the diagnosis and definition of tuberculosis of the spine in Ibadan.

METHOD

A restrospective study of the Computed Tomographic examination of 22 cases of spinal tuberculosis (Pott's disease) over a four-year period at the Radiology Department of the University College Hospital, Ibadan.

RESULTS

There was a male prevalence in the study. The mean age of respondents was 41.2 years. Neurological symptoms and back pain were the most common presentations. The thoracic spine was mostly involved while the cervical spine was least involved. Most lesions 77.3 % were demonstrated in two contiguous vertebral bodies. The vertebral bodies were destroyed in all the patients while the posterior elements were involved in 59%. The other CT findings were paravertebral soft tissue shadow in 40.9%, narrowed irregular disc spaces in 27.3% and fusion of vertebral bodies in 13.6%. The frequent bony destruction was osteolytic in nature, and was present in 64% of patients.

CONCLUSION

CT is an adequate modality for thorough imaging and diagnosis of Pott's disease especially in patients with non specific or ambiguous presentations. It offers a unique opportunity of demonstrating clearly the various component of the spine, it also defines the pattern and extent of the destructive process.

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.

Femoral head diameter in subcapital fracture of the femur in Ibadan, Nigeria

Subcapital fracture of the femur is common in the elderly patients though the incidence is less in our environment than in the western world. Primary prosthetic replacement is the method of treatment in the majority of the patients. To facilitate this, a foreknowledge of the femoral head diameter is necessary. To determine the diameter of the femoral head and its magnification on radiograph among patients with hip fractures seen in South-West Nigeria, all patients with subcapital fracture of the neck of femur seen between March 1997 and February 2002 were included in the study. The femoral heads were measured on the radiographic film using a transparent ruler and after extraction of the femoral head during surgery using callipers. There were 25 patients in all, the mean age of patients was 73.2 years. Fall at home accounted for 70% of the cases. The femoral head diameter was between 42 mm and 50 mm in 92% of patients while magnification of femoral head diameter on radiograph was 10-14% in 92% of cases. The usaof 10-14% magnification of femoral head on radiograph would help the surgeon determine the size of prosthetic head before commencement of surgery.

Computed tomography (CT) in civilian gunshot head injuries in Ibadan

BACKGROUND

There is data on civilian gunshot injuries in Nigerians. The purpose of the study is to describe the Computed Tomography findings of civilian gunshot injuries (GSI) to the head in Ibadan, Nigeria.

METHOD

This is a retrospective study of Computed Tomography (CT) films and clinical records of 28 consecutive civilian gunshot injuries to the head from 1996 to 1999.

RESULTS

The gunshot injuries to the head were mostly armed robbery related. Though there was a steady annual increase of civilian gunshot injuries during the study period, a low CT Scan frequency (0.61%) was recorded. The following CT findings were present in all the patients; bullet fragments, intraparenchymal haemorrhage, vault fractures and soft tissue swelling. The resting position of the bullets showed a predilection for the parietal lobe (32.1%) and the most common fracture site was also the parietal bone (42.8%).

CONCLUSION

CT findings simplified the management of civilian gunshot injuries to the head in the patients studied by demonstrating the exact pathology sequel to the injury. Despite important constraints, CT remains a cost effective means of managing GSI to the head.

Presentation of primary mediastinal masses in Ibadan

OBJECTIVES

To determine clinical features, anatomic location and histological types of primary mediastinal masses diagnosed and treated in a black African population.

DESIGN

A retrospective study of clinical data collected from patients case notes, the cardiothoracic unit's and pathology records between June 1975 and May 1999.

SETTING

University College Hospital, Ibadan, Nigeria which hosts a major cancer center in the West African sub-region, and serves community clinics.

PATIENTS

All patients with primary mediastinal masses referred for evaluation and treatment.

MAIN OUTCOME MEASURES

Excluded metastatic, oesophageal and vascular-lesions. All patients had radiological evalulation and tissue biopsies. The anatomic subdivision of the mediastinum into anterosuperior, middle and posterior section was used.

RESULTS

One hundred and five consecutive patients were evaluated and treated. The mean age was 34.0 +/- 20.4 years. There were 75 males and 30 females. Eighty one (77.1%) were symptomatic, 24 (22.9%) were asymptomatic. Thirty seven (45.7%) of the symptomatic patients had malignant disease while 44 (54.3%) had benign disease. Forty five patients (43%) and 60 patients (57%) had malignant and benign diseases respectively. Incidence of symptoms, was 82.2% for malignant and 73.3% for benign diseases. This difference in incidences is statistically insignificant (p=0.283). Majority of asymptomatic patients (70.8%) had benign disease while 29.2% of patients with malignancy were asymptomatic. This difference in incidence was statistically significant (p=0.0039). The frequency of mediastinal masses were anterosuperior, in 67 patients (63.8%), posterior mediastinal, 24 patients (22.9%) and middle mediastinal in 14 patients (13.3%). Lymphoma 23 (21.9%), thymus glands tumours 19 (18.1%) and endocrine tumours (goiters) 18 (17.1%) were the commonest types of primary mediastinal masses treated.

CONCLUSION

Majority of our patients with mediastinal masses (whether benign or malignant) are symptomatic and the absence of symptoms is more associated with benign disease. Majority of lesions are situated in the anterosuperior mediastinum. Lymphoma is the most frequent primary mediastinal mass.

Computed tomographic evaluation of Pott's disease in Accra

BACKGROUND

Radiological investigations are central in the diagnosis and management of TB spine. In Ghana there is a dearth of literature on the disorder. This paper seeks to describe the CT features of the bony and soft tissue changes in Pott's disease.

METHOD

It is a descriptive report of the CT scans performed on 30 patients with proven Pott's disease from January 1998 to December 2000 at the Korle Bu Teaching Hospital Accra, Ghana.

RESULTS

The disorder was common among children and young adults (76.7%). Chronic back pain was the frequent presenting complain (53.3%). The dorsal spine remains the site of preference while T11 recorded the highest incidence (73.3%). The vertebral body was destroyed in all the cases and the fragmentary type of bone destruction was the common observation. The incidence of cord compression demonstrated by CT was high (73.3%). Other findings were paraspinal and epidural masses observed in (66.7%) and (73.3%) respectively.

CONCLUSION

CT images demonstrated the spinal level of destruction. Improved resolution also showed detailed changes within the outlined soft tissue masses, facilitating early diagnosis and prompt initiation of therapy.

Women with painful breasts without palpable masses: do they really need a mammogram?

This prospective study was carried out over a period of 36 months, and the study population was, all the women (726) referred for mammograms on account of painful breast(s) without palpable masses. They were matched with the same number of asymptomatic women in a control group. The mammographic findings in the women with painful breast(s) and no palpable masses were normal in 639 (88%), benign in 80 (11%), suspicious in 2 (0.3%) and malignant in 5 (0.7%). In the control group mammograms showed normal breasts in 625 (86.1%), benign and suspicious lesions in 87 (12%) and 7 (1.0%) respectively. Malignant lesions were recorded in 7 (0.9%) women. The prevalence of breast cancer was similar in women with painful breast(s) and the control asymptomatic cases. Our reports show that inspite of the pain experienced by the women in this study mammography had a low diagnostic yield of malignant lesions, just as it was found in the control group. Mammography therefore, in these patients will only provide reassurance.

A review of gall bladder carcinoma in Ibadan

Twenty cases of histologically proven carcinoma of the gall bladder (GB) seen in the University College Hospital, Ibadan, Nigeria between 1983 and 1997 were reviewed. There were seven males and thirteen females, thus giving a sex ratio of 1:2. The majority of the cancers occurred between the fourth and seventh decade of life. The pre-operative diagnosis has improved and about 70% of the ten patients with adequate clinical information had definitive surgical treatment. The advent of new imaging techniques at this hospital, consisting of ultasound (US) and computerized axial tomography(CT) has made pre-operative diagnosis possible. This is in contrast to the situation noted twenty years earlier in a similar study. Surgical intervention can now be timed and planned appropriately in the majority of cases although late presentation is still a problem. With earlier presentation, prompt diagnosis and appropriately planned surgery, a better survival figure is anticipated at this institution.

The place of clinical features and standard chest radiography in evaluation of mediastinal masses

One hundred and five primary mediastinal masses were seen between 1975 and 1998, at the Cardiothoracic surgical Unit of the University College Hospital Ibadan. These were studied to establish the importance of clinical features and plain chest radiography in preoperative evaluation of these masses. The sources of information were unit's record, cancer registry and the patients case note. The age range of the 75 male patients was 3 to 80 years (mean 35.2 +/- 22.1 year) and for the 30 female patients was 2.5 to 70 years (mean 30.9 +/- 18.6 years). Anterosuperior mediastinal masses were the most common (63.8%) followed by posterior mediastinal masses (22.9%). Middle mediastinal masses made up the remaining (13.3%). The most common primary mediastinal tumour was lymphoma (21.9%) next to which were thymus gland neoplasia and thymus cysts/hyperplasia (18.1%). Endocrine tumours (mainly goiters) constituted 17.1% of the masses. On the whole, 45 (42.9%) of the mediastinal tumours were malignant and 60 (57.1%) were benign. Eighty one patients (77.1%) were symptomatic at presentation, 24 patients (22.9%) were asymptomatic. Malignancy was more associated with symptoms in this series (82.2%) and benign lesion were more frequently (70.8%) asymptomatic. Cervical lymphadenopathy (78.6%), was more frequent in patients with malignant lesion. Tracheal deviation (60.3%) and neurological signs (78.9%) were more frequent in benign disease. Superior vena cava syndrome was more frequently associated with primary malignant mediastinal tumours. All masses (100%) were visualized on plain chest x-ray. On the basis of clinical features and chest x-ray, majority of patients (76.2%) with primary mediastinal masses had exploratory thoracotomy, sternotomy or biopsy of their mediastinal mass.

Computerised tomography of intracranial subdural haematoma in Ibadan

The high mortality and morbidity associated with intra-cranial subdural hematoma (SDH), has declined significantly with the introduction of Computerised Tomography (CT) for the evaluation of the brain in suspected cases. One hundred patients with CT-diagnosed SDH at the Radiology department of the University College Hospital, Ibadan between January 1999 and December 2000 were reviewed. The mean age was 47.4 years. The most frequent cause of SDH was head injury 61 (61%). The observed CT appearances of SDH included 66 (66%) of chronic (hypodense), 30 (30%) of acute (hyperdense) and 4 (4%) of acute-en-chronic (mixed density) lesions. There were more unilateral 83 (83%) lesions than bilateral 17 (17%). The lesions were right-sided in 45 (45%) cases and left-sided in 38 (38%). A total of 169 lesions were detected as some patients had multiple sites, however, the parietal 78 (46.2%) and frontal 64 (37.9%) lobes were mostly affected. We conclude that brain CT scan offers the advantage of prompt determination and precise anatomical localization of SDH, which significantly aids management.

Reexpansion pulmonary oedema as a complication of pleural drainage

One hundred and one (6%) of 1,678 patient studied had bilateral reexpansion pulmonary oedema(RPO). On the whole, one thousand, seven hundred and seventy nine (1,779) pleural spaces were studied, fifteen pleural spaces (0.8%), with mean age of 23 +/- 4.5 years had RPO. Among these 15 patients with RPO, the mean period of lung collapse before pneumothorax (PThx) was evacuated was 31.8 +/- 21.8 days and for hydrothorax (HThx) was 31.3 +/- 30.1 days; for 15 patients without RPO (controls), matched for age and sex, the mean period of lung collapse before CTTD was 7.5 +/- 4.1 days and 5.4 +/- 1.3 days respectively for PThx and HThx. The differences in the period of lung collapse among patients with RPO and those without, for each pleural disease was statistically significant (P < 0.03). Volume of pleural fluid drained before RPO was noticed was 2196 +/- 1103 mls, for the 15 matched patients without RPO (controls), it was 1060 +/- 115 mls (p < 0.05). Volume of pleural fluid drained among the patients with SR (Severe response), MR (mild to moderate response) and RD (radiological diagnosis) did not correlate with severity of response. We conclude that prevention of RPO is the desired goal in the management of pleural effusion or Pneumothorax. RPO is commonest among young patients who have had lung collapse for 7 or more days. In these circumstances RPO is prevented, its incidence and severity reduced by methods of gradual evacuation of PThx or pleural fluid drainage.

CT evaluation of intracranial subdural haematoma: an Accra experience

This is a descriptive analysis of the Computed Tomographic (CT) findings in 50 cases of intracranial subdural haematoma in Accra. The majority of patients were adults, though no age group was immune. The frequent aetiological factor in the series was trauma. Other remote causes such as meningitis and sickle cell disease were reported. The male to female ratio was 2.6:1, while the mean age was 32.4 years. Subdural Haematoma (SDH) was classified into various subtypes by their CT densities. The commonest type, the hyperdense or acute haematoma was reported in 56% of the patients. CT features noted in the series, include ventricular alteration, seen in 31 (62%) and were more often noted in the acute and isodense bleeds. Ipsilateral effacement of cerebral sulci was observed in only 10% of cases. Concave haematoma borders were reported in 76%. SDH were more often found on the left aspect of the cranium (52%), particularly in the frontal and pariental lobes. Evacuated surgery was done in only 9 of the series, where haematoma was demonstrated in more than 3 tomographic slices. Flake-like calcifications were found in three cases of long standing haematoma. Against the above background CT can be described as an appropriate diagnostic tool in clinical evaluation of SDH.

Pattern of intrathoracic goiter in Ibadan, Nigeria

This study is to review the pattern of intrathoracic goiter in a large black population. In a retrospective review, the cardiothoracic unit managed ninety-eight primary mediastinal masses of which sixteen patients with intrathoracic goiters were treated during the same period. This constitutes 1.3% of treated goiters and 16.3% of primary mediastinal masses. Seventy-five per cent of the intrathoracic goiters were in association with cervical goiters. Twelve of the intrathoratic goiters were located in the anterosuperior mediastinum, and two in the middle mediastinum. There were three goiters in the posterior mediastinum. Six patients had cervical exploration and median sternotomy, three had cervical exploration and thoractomy, 3 had only thoractomy, two had only median sternotomy for excision. Thirteen patients (81.3%) had either simple colloid or multinodular intrathoracic goiter, one had follicular adenoma, and 2 patients had malignant goiters. One patient had recurrent cervical goiter. The endemicity of thyroid disease does not seem to increase the frequency of intrathoracic goiter.

Ultrasound assessment of the effect of parity on postpartum uterine involution

A longitudinal study of 300 women in the puerperium was undertaken in an African population. The aim was to determine the influence of parity on postpartum uterine diameters during involution. The patients were divided into two groups, nulliparous and multiparous based on parity. The uterine diameters were larger in the multiparous group when compared with the nulliparous group. Further analysis revealed positive (Pearson's) correlation between parity and uterine diameters and uterine volume. There was no significant correlation between parity and uterine volume on the 42nd puerperal day. In conclusion, Negroid patients have large uteri, which correlate in size positively with parity.

Trans-hiatal oesophagectomy as palliative treatment for carcinoma of the oesophagus

OBJECTIVE

To determine the role of palliation with trans-hiatal oesophagectomy in Nigerian patients with carcinoma of the oesophagus.

DESIGN

Prospective case series. The first series was from February 1986 to September 1987 (Series A) while the second series was from March 1989 to November 1996 (Series B).

SETTING

Cardiothoracic Surgery Unit (CTSU) of the University College Hospital, Ibadan, Nigeria.

SUBJECTS

First series consisted of 10 consecutive operable patients with carcinoma of oesophagus seen over the period of study. The second series consisted of 21 consecutive patients with same disease.

INTERVENTION

All patients had transhiatal oeosphagectomy by a two team approach and immediate placement of the freed stomach in the posterior mediastinum and cervical oesophagogastrostomy.

RESULTS

Patients in both series had a comparable age range of 43 - 80 years for series A and 40 - 82 years for Series B. The duration of symptoms were 2 - 6 months and 2 - 12 months respectively, for series A and B. In series A, nine patients had carcinoma of the middle-third (M1/3) of the thoracic oesophagus and one patient had carcinoma of lower-third (L1/3) of the thoracic oesophagus. In series B, 18 patients had M1/3 and three patients had L1/3 lesions. Average blood loss in series A was 1,067 mls, corresponding value for series B was 852 mls. Postoperatively, all cases were classified as stage III or stage IV disease. There were 18 complications in eight patients in series A and 22 complications in 10 patients in series B. The commonest complications in series A were pleural enteries in six patients, haemorrhage four patients (three intraoperative, one post-operative) and respiratory failure (two patients). The commonest in series B were pleural enteries in nine patients, anastomotic leaks and stenosis in four patients and respiratory failure in three patients. Hospital mortality was 50% in Series A and 14.3% in series B. The causes of death were haemorrhage and respiratory failure in series A, respiratory failure in series B. Survival period in series A of the five patients discharged was for a median of 84 months, for series B, four patients were alive at 18 months post-operative, one patient attended follow-up clinic 24 months after surgery. No other adjunctive therapy was offered to the patients.

CONCLUSION

Trans-hiatal oesophagectomy is a procedure suitable for patients with carcinoma of the oesophagus and affords palliation at an "acceptable price" among carefully selected patients with advanced carcinoma of the oesophagus.

Abdominal computed tomographic scan-merits and demerits over ultrasonography: evaluation of 70 cases

Computed tomography (CT) and Ultrasonography (USS) are commonly used to ascertain the cause of abdominal symptoms. In a retrospective study of 70 Nigerian patients who had abdominal ultrasonography prior to abdominal CT scans, the most frequent clinical feature was abdominal pain, which was reported in 20.8% of the patients. The prevalent ultrasonographic finding was hepatomegaly (12.2%) while bowel displacement was the most frequently reported CT finding (18.3%). There was no correlation between USS and CT findings in 11 patients (15.7%). There was some agreement in the findings of both tests in 75.7% of cases. Additional findings were noted in 38 (54.3%) of the latter group of patients on CT scans. Hundred percent agreement was reported in both imaging techniques in 5 radiological findings namely: dilated gall bladder, renal cysts, ascites, adrenal mass and utero-cervical mass. These findings suggest a high yield of diagnostic accuracy from abdominal sonography and increased diagnostic details provided by CT imaging. Our overall impression is that the diagnostic information provided by the two techniques are complimentary.

Neonatal teratoma of the neck causing respiratory distress: a case report

This is a case of a neonate with a large cervical mass and respiratory distress at birth. Radiological investigations revealed a predominantly solid mass with calcifications and multiple cysts, suggesting a teratoma. Patient died while being prepared for surgery and autopsy confirmed an immature teratoma. The clinical and pathological characteristics of paediatric cervical teratomas are discussed.

Cholelithiasis in Ibadan: an update

This study is to ascertain the present status of cholelithiasis in our environment. Six hundred and seventy (670) consecutive abdominal, ultrasounds done for various abdominal complaints at the University College HospitaL Ibadan from January 1977 to December 1998 were studied for gall stones in addition to other studies of the abdomen. Only twelve (12) gallstones were found, giving a prevalence of 1.79%. Only 25% were silent stones. The male:female ratio was 1:3. The mean age was 30 years (S.D = 2.8) and peak age was between 30 and 40 years. The average body mass index (B.M.I) was 23.49 kg/m2 (S.D = 3.9). The average parity among the women was four (4). Only one ultrasound was false (false negative). This study shows an increase. In prevalence over previous figures (1.79%) as against 0.007% in the sixties). The peak age is a decade lower and the anthropometric measurements in our patients do not support the typical caucassian model.

Computed tomographic patterns of intracranial infarcts in Ghanaians

Computed tomography has given a boost to intracranial imaging in general, and the diagnosis of the subtypes of Cerebrovascular Accident (CVA) in particular. In this study of 1,172 cases of CVA examined by Computed Tomography (CT), 552 (47.10%) showed features of cerebral infarction. There was a male prevalence in the study and the mean age was 59.8 years. As in all infarcts the diagnostic appearance was a wedge shaped hypodensity within the brain parenchyma. This was most often found in the parietal lobe (73.6%) and was always without a mass effect. Even though solitary infarcts were frequent, multiple lesions were reported in 9.3% of cases and these group of respondents presented mostly with seizures. Diabetes mellitus was an important predisposing factor and was found in 163% of cases, while hypertension was found in only 9.1% of cases studied. Other CT findings were cerebral and cerebrellar atrophy. Calcification of the falx and the basal ganglia were also noted.

Spontaneous intracranial haemorrhage: computed tomographic patterns in Accra

The diagnosis of stroke and the ability to distinguish the subtypes is central in the management of patients. This CT study has confirmed an increased prevalence of stroke (CVA) among Ghanaians. It has also reaffirmed a relatively higher incidence (52.9%) of spontaneous intracranial haemorrhage over cerebral infarcts among the 1,172 stroke patients studied. The study points to a male preponderance and a mean age of 55.7 years. Parenchymal haemorrhage was found to be the commonest variety of these haemorrhages. It occurred in 83.6% of cases while primary subarachnoid haemorrhage was reported in only 8.1% of cases. Ventricular extension of the parenchymal haemorrhage was reported in 22.7% of cases. The latter were mostly unilateral and on the left side especially in the parietal lobe (70.9%), subdural haemorrhage like the parenchymal variety was also reported to be more on the left, mainly unilateral and acute. Haemorrhages in the cerebellum and pons which are normally difficult to diagnose were also outlined with ease in the CT images. Other CT findings in these patients include parilesional oedema and mass effect found in 87.10% and 77.4% respectively.

Anterior mediastinotomy--a diagnostic tool

This is a review of our experience with anterior mediastinotomy (AM) in the diagnosis and evaluation of diseases of the mediastinum and lung. Thirty consecutive patients who had AM between 1984 and 1999 were retrospectively studied. The mean age of patients was 28 +/- 6.5 years. There were 22 males to 8 females. Sixteen patients had superior vena cava (SVC) obstruction (12 patients with lung cancer, 4 with primary mediastinal tumours), 4 patients had radiological evidence of mediastinal contiguity of upper lobe tumours and 10 patients had primary mediastinal tumours. AM was 1st procedure in 10 patients and 2nd procedure in 20 patients after failed or inconclusive result from FNAB, scalene node/cervical lymph node biopsy or bronchoscopy. Eighteen right-sided and 12 left-sided AMs were performed. Satisfactory histological diagnoses were achieved in all patients. Complications were easily controlled bleeding (4 patients) and life-threatening haemorrhage in 2 patients. Three patients had delayed wound healing and 4 had inadvertent pleural entries. There was no mortality temporarily related to the procedure. We conclude that AM is valuable as a surgical technique for obtaining tissue for histological purposes in diseases of the mediastinum and the lung when tissue specimens from less invasive procedures are unsatisfactory.

Experience with computed tomography (CT) pelvimetry in Ibadan, Nigeria: a preliminary report

Computed tomography (CT) pelvimetry has largely replaced conventional radiography in the antenatal assessment of pelvic dimensions, but its usefulness in the Nigerian setting is yet to be assessed. This study was undertaken to ascertain if there is a relationship between antenatal CT pelvimetric measurements and the mode of delivery at the end of the pregnancy. A group of thirty-one patients who had antenatal pelvimetry were categorised into two groups depending on whether they achieved vaginal delivery or not and the pelvimetric and other obstetrrc characteristics of the two groups were compared. The only parameters that showed statistically significant differences between the groups were the higher maternal height and the lower head circumference in the neonates of women achieving vaginal delivery. The findings suggest that fetal parameters may be more predictive of mode of delivery than absolute pelvic measurements.

Radiological ageing process in the cervical spine of Nigerian women

The study was designed to determine the age of commencement of ageing process in Nigerian women Four hundred (400) consecutive women requesting for cervical spine radiographs where recruited for this study. A study chart was made showing different variables like osteoarthrosis, detached osteophytes, postural ulterations and disk degenerations in a four year period from 1st January, 1993 to 31st December, 1996 the modified Kellgren and Lawrence grading system was used to assess radiographic changes. The highest rate of osteoarthrosis (31.13%) was found in the fifth decade. Incidence of postural alterations of the cervical spine rose sharply in the 5th and 6th decades of life. Grade 2 osteoarthrosis (Kellgren and Lawrence) was commonest (61.3%); Grades 3 and 4 had the lowest incidence (3.45%). Disc degeneration was commonest in the 5th; the most involved disc was C5/C6 and the least involved was C2/C3. It is concluded that the ageing process in the Nigerian women commences in the fourth decade of life, and apparently shows no difference with caucasian women.

Radiological evaluation of head trauma by computer tomography in Ibadan, Nigeria

The computed tomography (CT) findings of 419 patients with head injury were reviewed. 254 (60.62%) showed abnormal CT findings while 165 (39.38%) had a normal CT examination. Pathological states, which were easily demonstrated by CT, include traumatic haemorrhages (i.e. intracerebral bleed 67 cases (26.3%), Subdural haematoma 73 cases (28.7%), cerebral oedema and other cerebral sequelae of trauma such as porencephalic cysts, cerebral infarction and leukodystrophy. Patients with focal neurological deficit showed more positive findings than those without. A total of 73 (17.42%) patients had fractures demonstrated on CT. 39 (23.2%) of the 168 patients with traumatic haemorrhages had associated fractures. Fractures were detected more in patients with intracerebral and epidural haemorrhages than subdural haemorrhages. Plain skull radiography alone is therefore not sufficiently valuable in investigating patients with head injury. Computed tomography, no doubt, offers an excellent method of investigating the patient with head injury in that it demonstrates intracranial or cerebral lesions that may or may not be associated with fractures; and which might be missed if CT is not done. CT examination should be obtained where it is available if clinical indication warrants it and when CT is to be done, plain films are irrelevant since CT with bone window settings and with 3D reformation would show fractures.

Radiological evaluation of orbital tumours in Ibadan, Nigeria

Tissue diagnosis of orbital tumours is especially difficult because of the wide range of tissues normally occurring in the orbit [2]. Unfortunately, such tumours are relatively surgically inaccessible for biopsy due to the presence of the bony walls of the orbit and its peculiar shape. This gives rise to a need for effective methods of indirect assessment of the orbit and its contents prior to definitive therapy. Such indirect assessment may be achieved using certain modalities of radiological imaging. These include conventional plain X-ray films, ultrasound scan (USS) and computerized axial tomography (CAT scan), orbital venography and magnetic resonance imaging. This paper is a pilot study of current practices in the use of radiological imaging techniques in the diagnosis of orbital tumours at a University Hospital.