Home Print this page Email this page Users Online: 223
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ARAWA 2012 PROCEEDINGS
Year : 2013  |  Volume : 20  |  Issue : 1  |  Page : 50-64

ARAWA 2012 Proceedings


Date of Web Publication7-Sep-2013

Correspondence Address:
Login to access the Email id


Rights and Permissions

How to cite this article:
. ARAWA 2012 Proceedings. West Afr J Radiol 2013;20:50-64

How to cite this URL:
. ARAWA 2012 Proceedings. West Afr J Radiol [serial online] 2013 [cited 2019 Sep 19];20:50-64. Available from: http://www.wajradiology.org/text.asp?2013/20/1/50/117900

Proceedings of the 50 th Annual Conference of the Association of Radiologists of West Africa ( Arawa0 ) June 2012, Ibadan, Nigeria


  Address by LOC Chairman Top


Dear Friends and Colleagues,

Once again, I have the pleasant duty and privilege, on behalf of our great Association, of welcoming you to this year's conference; the 50 th Annual Scientific Conference and Golden Jubilee Anniversary of Association of Radiologists of West Africa, tagged ARAWA 2012.

This week we will all put aside the demands of normal work to have the chance of meeting colleagues and catching up on gossip, recharging our intellectual stores and finding out what is going on in our specialties outside our own immediate spheres. The contents of this program booklet and abstracts book are stimulating and knowledge based. It provides exciting and diverse topics within the clinical and scientific fields of radiology. I am especially pleased to welcome and congratulate our 50 th Anniversary Guest Speaker, Prof. Francis Abayomi Durosinmi-Etti (OFR), and to draw your attention to the recognition of the increasing importance of Cancer in all our specialties including its antecedent burdens on the quality of life in our community.

A large number of health professionals and renowned speakers are attending this big event. Other participants will include equipment manufacturers, suppliers and company representatives. This conference is therefore expected to give Government bodies, decision makers and other stakeholders in the health sector the opportunity to meet, discuss and exchange knowledge and ideas on the cutting-edge of technology in radiology and radiotherapy including issues relevant to health care in member countries in the West African sub-region.

I wish to recognize the sustained effort from a large number of people, including the Conference Committees, the secretariat, the Executives of our Association and our partners in the medical industries I can only express profound gratitude on behalf of all of you, delegates, to everyone who has worked to make this meeting a success.

With a full scientific program during the day, it is important that delegates have time to relax and meet with new and old friends and explore the entertainments in the fun-loving city of Ibadan.

I hope you will find the conference valuable and enjoyable. Hopefully, our meetings will continue to grow from strength to strength in the years ahead, and be an investment in scientific and technological developments of the future. Welcome!

Dr. Biodun Adeyinka,

Conference Chairman, ARAWA 2012


  President's Address Top


On behalf of the executive committee and the entire members of the Association of Radiologists of West Africa, it is my honor and privilege to welcome you all to the 50 th Annual Scientific Conference and General meeting of our great association, holding in the historic city of Ibadan.

Our great association ARAWA was founded, 50 years ago by our visionary leaders with the aim of fostering development in the fields of research, professionalism and social interactions. A large percentage of these goals have been achieved. The major factor militating against the full achievement of all the objectives is the disproportionate rate of technological advancement in our countries when compared to the developed countries, as our profession is largely technology based.

The theme of this year's conference "The Current Challenges in the management of Cancer in sub-Saharan Africa-Impact of Medical Imaging" is very apt, considering the morbidity and mortality resulting from various forms of cancer in this sub-region, owing to late presentation and diagnosis. I believe it will go a long way in sensitizing the public to the importance of routine screening, especially for breast and cervical cancer, and our governments in the provision of the necessary equipment needed for the achievement of this objective.

I wish to commend the Local Organizing Committee that has worked tirelessly to ensure a smooth, hitch free and memorable golden anniversary of our great association, in spite of the myriads of challenges, especially that of finance. We had a wonderful outing in Kano last year and I believe this year's will be even better. In the same vein, I would also wish to thank all our sponsors both corporate and individual for their support. As the popular adage says "a friend in need is a friend indeed".

Finally I wish all the participants a successful meeting and implore all guests to explore the rich cultural heritage that the historic town of Ibadan has to offer.

Your excellences, participants, distinguished ladies and gentlemen you are once again welcome to the great city of Ibadan

Dr. K Isyaku, MBBS, FWACS, FMCR.


  ARAWA Planning Committee Members Top


Finance Committee

DR ADEYINKA

DR. A.C NUHU

DR. O.S AFOLABI

DR. OGUNORIN OLUTOYE

DR. JATTO

Ceremonial Committee

DR. TINU AGUNLOYE

DR. F. ANOR

DR. E.A OKAFOR

DR. E.A IDOWU

DR. B.P YUSUF

DR. O.O OSOFUNDIYA

DR. L.O ERIBA

DR. OKWOR VITALIS

DR. ALI-GOMBE

DR. B. BELLO

DR. M.A JIMOH

Scientific Programme Committee

DR. OGBOLE/DR AKINMOLADUN

DR. D.U UDOFIA

DR. D. OLUSUNMADE

DR. R.C EFIDI

DR. I.H UKACHUKWU

DR. K.I ISEKO

DR. FOLUKE SARIMIYE

DR. IKHILE EMMANUEL

DR. A.E OMIKUNLE

DR. A.A OLADEJI

DR. ALIYU

Publicity Committee

DR. ABDUS-SALLAM

DR. E.O OLABINRI

DR. B.E OSOBU

DR. C.E UKAIGWE

DR. R.B OLATUNJI

DR. M.O AKINWUNMI

DR. HASSAN

DR. LASEBIKAN

DR. TAIWO T.

DR. ADEWALE

DR. MUSTAPHA

Transport and Welfare Committee

DR. ATALABI

DR. T.O SOYEMI

DR. I.O AREMU

DR. A HAFIZ

DR. C.J ODO

DR. O. BAMIDURO

DR. O.O OYIBOTHA

DR. ASAOLU

DR. O.E OBOH

DR. B.C SALAKO

DR. BIYI OLUTUNDE

Exhibition

DR. A. J. ADEKANMI

Administration

Yetunde Awosika-Fadahunsi


  1st Scientific Session Top


Percutaneous pulmonary arteriography and catheter directed thrombolysis of pulmonary thrombo embolism in Kano: Report of two cases

Abdulkadir M Tabari, Mamuda Atiku 1 , Ismail Anas


Departments of Radiology, 1 Anethsiology, Aminu Kano Teaching Hospital, Kano, Nigeria

Correspondence: Dr. Abdulkadir M Tabari,

Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria. E-mail: amustabari@yahoo.com

ABSTRACT

Background:
Accurate diagnosis of pulmonary embolism (PE) is crucial, because it carries a significant degree of mortality if not diagnosed early. Pulmonary digital subtraction angiography (DSA) has remain the gold standard in the diagnosis of PE. Treatment of PE offers a 10-fold reduction in mortality, while non-treatment is associated with 30% mortality. Aims and Objectives: This report is on the first case of catheter directed thrombolysis of PE performed in Kano, Nigeria. It intends to highlight the technique, challenges and prospects of this procedure in our typical resource poor setting of sub-Saharan Africa. Materials and Methods: A case of 46-year-old man who developed PE from right popliteal vein thrombosis following surgery for femoral supracondylar and fibular fractures was presented. The clinical features, and imaging characteristics of PE on multi-detector CT (MDCT) and DSA were highlighted. Step by step technique of pulmonary arteriography and catheter directed thrombolysis was outlined. Results: Successful lysis of the pulmonary thromboembolism was achieved in part via catheter directed thrombolysis using streptokinase. Transient intra-procedural bradycardia on catheter entry to the right ventricle was encountered. However, patient did well after the procedure. The limitations of the procedure relevant to our setting was highlighted. Relevant literature on the subject was also reviewed. Conclusion: The diagnosis of PE can be achieved with high degree of accuracy using MDCT. Catheter directed thrombolysis is safe and efficient way of treating PE.

Key words: Catheter directed thrombolysis, pulmonary embolism, technique

Computed tomographic evaluation of intra-abdominal tumours in Aminu Kano Teaching Hospital, Kano, Nigeria

Anas Ismail, Suleiman A. Saidu, AbduH Dambatta


Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria

Correspondence: Dr. Anas Ismail,

Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria. E-mail: ibnmalikanas@yahoo.co.uk

ABSTRACT

Background:
Abdominal tumors are increasingly becoming common indications for abdominal computed tomography (CT). CT is an important imaging tool that can provide valuable diagnostic information that is unavailable on clinical examination. It will also determine the tumor characteristics, vascularity, extent of the disease, and staging for treatment and prognostication. Materials and Methods: A spiral multisliced (four slices) bright speed GE CT scanner was used for the abdominal CT. Both pre- and post-contrast images, with coronal and sagittal reformatted images were taken from the dome of the diaphragm to the symphysis pubis. All abdominal CT done between April 2011 and April 2012 were retrospectively reviewed. The cases of radiologically diagnosed intra-abdominal tumors were selected and further analyzed. Results: Out of 60 examinations reviewed, 41 patients had abdominal masses. Their mean age was 50.15 ± 16.79 years. Males constituted 56.1% while 43.9% are females. There are 13 cases of pancreatic masses, constituting 31.7%; followed by hepatic tumors, contributing 26.8%. Ovarian and prostatic tumors contributed 12.2% and 4.9% respectively. Other fairly common tumors encountered include gastric, retro-peritoneal and colo-rectal. About 46.3% of these tumors produce obstructive effects on the adjacent luminal structures. Ascites is present in only 29.3% (12) of them while 70.7% (29) did not present with ascites. The frequency is also the same for those with local invasion/infiltration and those without, respectively. lypmphadenopathy was present in four cases (9.8%) and majority of them are hypovascular (73.2%). At the time of the scan, no obvious evidence of metastatic deposit was seen in 87.8% of the patients. Conclusion: Pancreatic and hepatic are the most common tumors in these series. There is great value of CT scan as an excellent imaging modality for evaluation of these tumors much more than the available modalities in our setting.

Key words: Abdominal tumors, computerized tomography, Imaging modality

Advanced ovarian tumours: Reliability of ultrasound in predicting findings at surgical exploration: A review of 44 cases surgically managed at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria (2005-2011)

Eric O Umeh, Chisolum O Okafor, Cornelius Ukah 1 , Obiorah C Okpala, Gerald O Udigwe 2


Departments of Radiology, 1 Pathology and 2 Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Correspondence: Dr. Eric O Umeh,

Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria. E-mail: erada1996@yahoo.com

ABSTRACT

Background:
Ovarian tumour characterization is essential in determining treatment choice and extent. Sonographic morphology provides valuable information regarding risk of malignancy and facilitates clinical and surgical management. We reviewed ultrasound features of advanced ovarian tumours and determined the accuracy of pre-operative ultrasound in predicting surgical findings. Materials and Methods: Medical records of 44 females managed surgically for ovarian tumours at Nnamdi Azikiwe University Teaching Hospital, Nnewi (2005-2011) were reviewed. Histological tumour diagnosis and pre-operative abdominal ultrasound were done. Results: Study population's mean age 44.9 years, greater proportion premenopausal (68.2%) and low parity (58.1%). Prevalence of benign and malignant tumours, 36.4% and 59.1% respectively. On sonography, higher proportion of tumours are complex (52.3%), measuring well in excess of 10 cm (56.3%). For ovarian tumour detection, ultrasound sensitivity and positive predictive value (PPV), 85% and 89.7%. Sensitivity and PPV for bilateral tumours and localisation, 18%, 100% and 28%, 91% respectively. Sensitivity for cystic, solid and complex tumours using surgical findings as gold standard, 54%, 55%, and 82% respectively. Predicting tumour size (68-73%). Sensitivity for ascites (86%). Concordance of surgical and ultrasound impressions, 73% and 38% for benign and malignant tumours respectively. Conclusion: Ultrasound accurately predicts tumour size, character and presence of ascites. Unreliable at localising large tumours and detecting bilateral masses. Ultrasound and surgical impression are 73% concordant for benign tumours. Adhesions, tumour seedling, lymphadenopathy are inadequately resolved sonographicaly.

Key words: Advanced ovarian tumours, surgical exploration, ultrasound

Ultrasound as an adjunct in the diagnosis of advanced ovarian tumours: A review of 44 cases surgically managed at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria (2005-2011)

Eric O Umeh, Chisolum O Okafor, Cornelius Ukah 1 , Gerald O Udigwe 2 , Obiora C Okpala


Departments of Radiology, 1 Pathology and 2 Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Correspondence: Dr. Eric O Umeh,

Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria. E-mail: erada1996@yahoo.com

ABSTRACT

Background:
The value of abdominal ultrasound in the diagnosis of ovarian tumours is emphasized in our environment where many patients present late with large tumours inadequately evaluated by the trans-vaginal approach. With the documentation of ultrasound features of advanced ovarian tumours and determination of specific findings associated with benignity or malignancy, evaluation criteria can be developed for accurate tumour diagnosis. We reviewed documented ultrasound findings in patients with advanced ovarian tumours, and determined the validity of abdominal ultrasound in the diagnosis of benign and malignant tumours based on sonographic features. Materials and Methods: Medical records of 44 females managed surgically for ovarian tumours at Nnamdi Azikiwe University Teaching Hospital, Nnewi (2005-2011) were reviewed. Histological tumour diagnosis and pre-operative abdominal ultrasound were done. Results: Study population's mean age is 44.9 years, greater proportion premenopausal (68.2%) and low parity (58.1%). Prevalence of benign and malignant tumours is 36.4% and 59.1% respectively. On sonography, higher proportion of tumours are complex (52.3%), measuring well in excess of 10 cm (56.3%). For malignant and benign tumours, ultrasound sensitivity and positive predictive value 83%, 68% and 32%, 67% respectively. Sonographic detection of ascites and complex cystic/solid features has strong association with malignancy and benignity respectively. Conclusion: For advanced ovarian tumours, abdominal ultrasound is a better predictor for malignancy than benignity. Ascites on abdominal sonography strongly suggests malignancy.

Key words: Advanced ovarian tumors, ultrasound diagnosis, abdominal ultrasound

Current role of ethical review committees in the practice of ethics in health research in Nigeria

Atinuke M Agunloye, Ayobami T Salami 1 , Abdu Lawan 2


Department of Radiology, University of Ibadan, Ibadan, 1 Institute of Ecology and Environmental Studies, Obafemi Awolowo University, Ile-Ife, 2 Department of Ophthalmology, Bayero University, Kano, Nigeria

Correspondence: Dr. Atinuke M Agunloye,

Department of Radiology, University College, Ibadan, Oyo, Nigeria. E-mail: tinuagunloye@yahoo.com

ABSTRACT

Introduction:


  • Several reports of unethical conducts of health research in developing countries
  • 2009 - clinical trial on chemotherapy not authorized by endoscopic retrograde cholangiography (ERC) conducted in a palliative care hospital in Malawi. Six patients died.
Tenofivir study - 2005:

  • Preventive anti-retroviral
  • 400 Cameroonian human immunodeficiency virus negative prostitutes-recruited for 4 Euros. Inadequate and inaccurate information
  • Feeling protected, women reduced their level of vigilance-increased the risk of infection
  • No treatment of infected people.
Trovan study:

  • Pfizer test of the drug Trovafloxacin-Kano state
  • Bacterial (meningococcal) meningitis epidemic in Tudun Wada, Kano, Nigeria in 1996
  • Impetus for change.
National Health Research Ethics Committee:

  • The NHREC - Inaugurated October 2005 by the Hon. Minister of Health
  • Produced National Code of Health Research Ethics in August, 2007-on website
  • Offshoot of the dormant Health Research Ethics Committee (HREC) which had been in existence since early 1980.
Regulates all processes concerning health research:

  • Research approval
  • Monitoring
  • Suspension, revision or termination of research
  • Registers IRBs/HREC
  • Organise training and educational programs
  • Certify short courses and diplomas in health research ethics.
Materials and Methods:

  • Ethical approval obtained from NHREC
  • 14 members (2F, 12M) of 3 HREC from 3 geo-political zones: The North-East (Maiduguri), South-West (Ibadan) and South-South (Calabar) were recruited by simple random sampling
  • Two-institutional and based in universities
  • One-regional state government ERC
  • Written consent obtained
  • Structured and pre-tested interview guides
  • Semi-structured interviews conducted
  • All interviews audio taped and transcribed
  • Each interview lasted about 30-60 min.
Results:

  • Membership of HRECs:
  • 9-15 members
  • By virtue of position or experience in ethics
  • Few members formally trained (<30%)
  • All the HRECs have legal advisers
  • Multi-disciplinary in composition.
HREC Meetings:

  • Once in 2 weeks to once in 4 months
  • Scientific and ethical reviews conducted together by the same committee
  • Experts in relevant fields are frequently asked to evaluate proposals.
HREC - Modalities:

  • All follow guidelines of NHREC
  • Applicants pay approval fee-N2000 to N20,000 - higher for sponsored projects
  • Applicants submit hard copies for all members
  • No monitoring of approved projects in 2 ERCS
  • One monitors but to be funded by researcher.
Funding:

  • Two ERCs rely solely on the processing fees
  • One ERC is funded by the institution.
Challenges of ERCs:

  • Busy members, irregular attendance of meeting and poor punctuality
  • Selection of committee membership is haphazard
  • Lack of remuneration and incentives to the members of the committee
  • Bureaucracy - if working under the bureaucracy system of the government-state or national.
Discussion:

  • HRECs/IRBs accredited by NHREC - 30
  • List on website
  • Guidelines for registration
  • Approval renewed every 2 years
  • IRB Authority-limited to institution and its staff >1 IRB allowed-jurisdiction stated, open channels of communication and no simultaneous submission of proposals.
IRBS:

  • B4 own approval-with approval of NHREC, institutions can have cooperative agreement with nearby IRB in same state or if none, in different state in same geopolitical zone or if none, the NHREC!
  • Functioning hampered by shortage of qualified human resources, imprecise definition of mandates and a highly scientific membership
  • The evaluation work is voluntary and ethical review is very limited
  • Delayed approvals and inadequate monitoring of approved research protocols.
Recommendations:

  • More funding should be allocated to the ethical committees for better functioning
  • Financial incentives should be provided for committee members for motivation and improved dedication
  • Proper monitoring and supervision of projects by the ethical committee to ensure compliance of researchers with approved project format
  • Ethical committees should insist that a final copy of research findings should be sent to them to influence policy
  • An agency may be set up by the government to collate all such research findings in the state or country
  • Supervisors should properly monitor their student's research to ensure that they also follow ethical guidelines
  • Training and re-training of ethical members to get them updated on ethical principles
  • Training of researchers on research ethics
  • Research funding to be increased and ensure autonomy of researchers from funders
  • Establishment of a forum for all IRBs and HRECs to meet, share knowledge and exchange ideas. This may be coordinated by the NHREC.
Key words: Ethics, ethical review committees, health research


  2nd Scientific Session Top


B-mode ultrasonographic measurement of inferior vena caval diameter among healthy adults in Kano, Nigeria

Abdu H Dambatta


Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria

Correspondence: Dr. Abdu H Dambatta,

Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria. E-mail: najibdambatta@yahoo.com

ABSTRACT

Background:
The inferior vena cava (IVC) is a thin-walled compliant vessel that adjust the body volume status by changing its diameter depending on the total body fluid volume. Sonographic measurement of IVC diameter has been reported as an alternative, rapid and non-invasive method of volume assessment of body fluids. The aim of this study is to determine the normal IVC diameter among healthy adults in Kano, Nigeria. Materials and Methods: Sonographic measurement of IVC of healthy adults with age ranging between 15 years and 65 years was done with the subject in the supine position. The intrahepatic portion of its diameter was measured at about 2 cm proximal to the hepatic veins in longitudinal plane in both inspiratory and expiratory phases of respiration. Three repeated measurements were done to reduce intra-observer variability. Results : A total of 400 adults comprising of 173 (43.3%) males and 227 (56.8%) females were recruited. The mean age of the subjects was 32.4 ± 10.9 years. The overall mean IVC (expiratory) diameter in this study was 16.7 ± 2.7 mm (range = 10.9-25.4 mm). The mean IVC (expiratory) diameter was slightly higher for males than for females (Males: 17.1 ± 2.8 mm; females: 16.3 ± 2.7 mm). This difference was statistically significant (P = 0.0022). There was a gradual decrease in IVC diameter with advancing age. Conclusion: This study was able to generate normal IVC diameter in a sample of Nigerians which may serve as reference for normal values in Black Africans.

Key words: Inferior Vena Cava diameter, B-mode ultrasonography, Nigerians

Acceptance of mammographic screening and diagnosis: Can the female health worker be an agent of positive change?

Philip C Okere, Olalekan S Aderibigbe, Salome N Ezeofor, Nneka I Iloanusi, Augustine C Imo 1 , Tagbo T Marchie 2 , S Kakale 3 , Felix U Uduma 4 , Ifeoma J Okoye


Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, 1 Departments of Radiology, Ebonyi State University Teaching Hospital, Abakaliki, 2 University of Benin Teaching Hospital, Benin, 3 University of Sokoto Teaching Hospital, Sokoto, 4University of Uyo Teaching Hospital, Uyo, Nigeria

Correspondence: Dr. Philip C Okere,

Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria. E-mail: pcnokere@gmail.com

ABSTRACT

Objective:
To evaluate the knowledge and acceptance of mammographic screening and diagnosis by female health workers in Nigeria as an index of their ability to become agents of positive change amongst other female populations. Materials and Methods: A structured questionnaire was administered on a total of 750 female workers in a multicentre study in tertiary hospitals in Enugu, Abia, Ebonyi, Benin and Sokoto. Results: Of a total of 750 female health workers sampled, 332 (44.3%) returned their filled questionnaires. Eighty-two percent (82%) of respondents had heard of mammography and majority (74.3%) for the first time in the hospital where they worked. Although 80.7% of respondents knew what mammography and over 83% knew what mammography could reveal, only about 66% thought that the procedure was very important and would recommend it to women with or without breast disease. However, only about 20% of health workers had themselves in the past 5 years done a mammography either for screening or for diagnosis. Comparatively 59.3% had never had a mammogram. Twenty percent of respondents (20%) declined to field an answer. Conclusion: There is an apparent disconnect between the knowledge of mammography, the willingness to recommend it to appropriate populations of women and the utilization of the services by female health workers. It is therefore doubtful if they can be effective positive change agents for other female populations.

Key words: Mammographic screening, Knowledge and acceptance, positive change

Histology of cervical carcinoma seen at Radiotherapy Department, University College Hospital, Ibadan

Abbas Abdus-salam, Lucy Eriba, 1 Adeola Abdus-Salam, 2 David Dawotola


Department of Radiotherapy, 1 Obstetrics and Gynecology, University College Hospital, Ibadan, 2 Department of Radiotherapy, ABUTH, Zaria

Correspondence: Dr. Abbas Abdus-salam,

Department of Radiotherapy, University College Hospital, Ibadan, Oyo, Nigeria. E-mail: adrusa@gmail.com

ABSTRACT

Background:
The outcome of treatment of invasive cervical carcinoma is dependent on many factors including the stage of the disease, the histological types and the degree of differentiation and treatment modalities available. Degree of differentiation or tumour histological grading is an important consideration in determining the prognostic outcome. We review 196 cases of cervical cancer seen in our Department over a 2 year period to see the pattern of histological classification with emphasis on tumour grading. Materials and Methods: This is a retrospective study carried out within the Radiotherapy Department of the University College Hospital, Ibadan. The records of patients seen over 2 year period between July 2008 and June 2010 were analysed. Data pulled out included age, disease stage at presentation, histological variant and the degree of differentiation. Results: Of all the patients, 178 had squamous cell carcinoma (SCC) amounting to 90.8% while 14 patients (7.1%) had adenocarcinoma. One patient each has their tumours characterized as adenocystic carcinoma, adenosquamous carcinoma, clear cell carcinoma and mucinous carcinoma. No other variant was seen in this series. A slight majority of the patients, 99 (50.5%) has poorly differentiated tumours, 64 (32.7%) has well differentiated tumours, while the rest 33 (16.8%) has moderately differentiated tumours. Of the SCC tumours, 95 (53.4%) were poorly differentiated, 58 (32.6%) were well differentiated while the remaining 25 (14%) were moderately differentiated. On the other hand only 3 of the 14 adenocarcinoma cases (21.4%) were poorly differentiated, five cases (35.7%) were well differentiated, while 6 (42.9%) were moderately differentiated. The difference in the degree of differentiation between squamous histology and adenocarcinoma was found to be of statistical significance with a P value of 0.002. The mean age was 54.01 and standard deviation of 11.86. More than three-quarters of the patients were between 40 years and 70 years. The incidence appears to rise steadily with age until it peaked among 51-60 year age group and decline steadily thereafter. Most patients presented with advanced stage diseases between stage 2b and 4b. Conclusions: SCC remains the leading variants of cervical cancer seen in our environment and a slight majority of patients present with poorly differentiated tumours.

Key words: Cervical carcinoma, histology, radiotherapy

Imaging of adrenal tumors

Funsho Komolafe, Haroun Dahniya


New Fujairah Hospital, United Arab Emirates

Correspondence: Dr. Funsho O Komolafe,

New Fujairah Hospital, United Arab Emirates.

E-mail: ofkomolafe@yahoo.com

ABSTRACT

Adrenal Incidentalomas:


  • Incidentally discovered in course of imaging for other pathologies
  • Recent increased prevalence following wide use of cross-sectional imaging
  • Best diagnostic tools
  • Multi-detector computed tomography (CT) and magnetic resonance imaging.
Others:

  • Ultrasonography
  • Positron emission tomography (PET)
  • PET/CT.
Types and Imaging Highlights:

  • Adenoma - rapid contrast washout
  • Adenocarcinoma - delayed washout
  • Myelolipoma - high fat content
  • Pheochromocytoma - intense contrast enhancement
  • Metastatic - slow washout
  • Intense enhancement
  • (Hyper-vascular metastases).
Common Adrenal Endocrine Parameters:

  • Serum cortisol
  • Serum catecholamines
  • Urinary vanillymandelic acid
  • 17-ketosteroid
  • Testosterone.
Case 1:

  • 57 year male
  • Cough, Rt. lower lobe pneumonia
  • Rt. Pleural effusion
  • CT to evaluate possible cavitation
  • Incidental Rt. Adrenal 6.5 cm × 5.3 cm myelolipoma.


Case 2:

  • 61 year male
  • CT urogram for possible ureteric calculus
  • Rt. Adrenal myelolipoma 10 cm × 8.7 cm.
Case 3:

  • 68 year obese female
  • Known diabetic and hypertensive
  • Fullness in Lt. flank
  • CT showed a 10.3 cm × 10.7 cm
  • Myelolipoma.
Case 4:

  • 52 year male
  • Hypertensive, obese
  • Smoker - 15 years
  • Newly diagnosed diabetic
  • Dull aching abdominal pain - 6 months.
Case 5:

  • 16 year, female
  • Headache and palpitation
  • O/E: Hypertensive and sweaty.
Rt. Flank mass:

  • USS: Complex mass inseparable from liver
  • CT: Features of pheochromocytoma.
CT guided percutaneous transthoracic lung biopsy-first experience in Ibadan, South Western-Nigeria

Godwin I Ogbole, Peter O Adeoye, Clement A Okolo, Kingsley I Iseko

Department of Radiology, University College, Ibadan, Oyo, Nigeria

Correspondence: Dr. Godwin I Ogbole,

Department of Radiology, University College, Ibadan, Oyo, Nigeria. E-mail: gogbole@yahoo.com

ABSTRACT

Evolution of percutaneous computed tomography
( CT) Guided Biopsy:

  • First case of CT guided Biopsy was first reported by Haaga and Alfidi in 1976 1
  • Common procedure done in many hospitals in the developed world
  • Has a better diagnostic accuracy than ultrasound or fluoroscopic guided Biopsies 1
  • High Sensitivity and Specificity for Malignancy (>90%) 2,3
  • Mortality rate is low (0.15%). 4
Indications: 5,6

  • New or enlarging solitary nodule or mass
  • Multiple nodules in a patient not known to have malignancy or prolonged remission
  • Hilar mass following negative bronchoscopy
  • Obtain material for culture when other techniques have showed no causative organism in persistent consolidation.
Contraindications:

  • Relative, benefit must be weighed against the risk
  • Bleeding diathesis/anticoagulant therapy
  • Contralateral pneumonectomy
  • Presence of bullae
  • Suspected hydatid disease
  • Suspected vascular lesion
  • Seriously impaired respiratory function
  • Patient preparation.
  • Clotting profile should be done
  • Platelet count >10,000/ml
  • Prothrombin time <1.4
  • Oral anticoagulants should be stopped before the procedure
  • Equipment includes CT, Biopsy needles and a full resuscitation tray.
Complications:

  • Pneumothorax remains the most common complication of CT-guided lung Biopsy about 40% of cases 7
  • Local pulmonary haemorrhage
  • Rare: Air embolism, neoplastic seeding and spread of infection
  • The Ibadan experience a 51-year-old female presented in the Surgical Clinic on account of imaging findings from the UK. No chest symptoms Had Simple Left Mastectomy and axillary clearance in UCH in 1992
  • Histology showed stage II left breast cancer
  • Imaging showed a 3 by 3 cm lobulated, isodense mass in the posterior region of the apical segment of the right lower lung lobe
  • Patient advised to have a lung biopsy of the mass
  • Scheduled as a day procedure
  • Patient was counselled about the procedure
  • An informed consent was obtained in the presence of her sister.
Technique:

  • Patient was gowned and an intravenous access was secured with a 20G cannula
  • Patient was laid prone on the CT Gantry and a Scout CT Scan of the entire chest was acquired at 10 mm interval
  • Pulmonary nodule was visualised in the apical segment of the right lower lung zone posteriorly with absence of the left breast shadow and mild bilateral pleural effusion
  • A Repeat Scan was done at 5 mm interval which showed the right nodule to be 60 mm from the midline and 42 mm from the skin surface at approximately the 6 th and 7 th intercostal space posteriorly
  • Adequate skin preparation was done over the entry site with savlon, povidone iodine and spirit
  • Local anaesthesia was administered with 1% Xylocaine
  • Four evenly spaced 16G cannula needles were placed on a thin strip of plaster and placed on the skin above the suspected nodule
  • The patient was then scanned with 1 mm cuts over the selected portion of the chest (F110-F130 on the CT Gantry)
  • Images showed the easiest access for the biopsy was between the 2 nd and 3 rd cannula needle from the medial end, 5 mm from their inferior tip, 42 mm from the skin surface and 60 mm from the midline
  • A 21G Needle was then inserted at this point up to a depth of 43 mm
  • A focused rescan was then done with the needle confirmed to be within the nodule
  • With a 5 ml Syringe fluid was then aspirated for cytology
  • A Tru-cut needle 18G was then inserted with the 21G needle track as a guide up to a length of 45 mm
  • Patient was rescanned with 1 mm slice cuts and the needle was confirmed to be within the pulmonary nodule
  • Tissue samples were then taken for histology and sent to the pathologist
  • Haemostasis was then secured. Patients vital signs were normal and monitored every 30 min for 3 h
  • Post Biopsy chest X-ray was within normal limits
  • Patient was discharged in stable condition.
Discussion:

  • CT Guided Percutaneous Biopsy allows precise location of target lesions
  • Percutaneous CT Biopsies are cost effective 8
  • In developed countries the slice of interest marked with radiopoaque markers. 9 We modified this with the use of metallic cannulas
  • The sensitivity and specificity for malignant lesions with percutaneous CT-guided biopsy is >90%, 2,3,10 which correlates with our cytological diagnosis of metastatic breast carcinoma
  • Tsukada et al., 11 and Li et al., 12 showed that the lesion size is a significant factor in diagnostic accuracy
  • Pneumothorax which is the most common complication. 13 Size, 14 as well as the pleural to lung distance, 13 influence the risk of pneumothorax
  • Yeow et al., also found a six fold increase of bleeding for lesions ≤20 mm and a 10 fold increase for lesions >2 cm from the pleural surface and the presence of a pleural effusion correlated with a decreased risk of bleeding, 14 this also corresponds with our procedure which showed no evidence of bleeding or pneumothorax
  • Geraghthy et al., on studies done on 846 CT-guided lung biopsies found that a smaller needle substantially decreases the risk of pneumothorax with comparable diagnostic accuracy, sensitivity and specificity for histopathologic diagnosis of Pulmonary Nodules. 16
Conclusion:

  • Percutaneous CT guided Lung Biopsy is a cost effective, accurate procedure for diagnosis of pulmonary lesions
  • Low dose CT techniques with improved image quality is now being advocated 17
  • Transthoracic CT guided needle Biopsy is feasible in our Hospital and can be an effective and safe procedure for evaluating undetermined lung lesions.
Key words: Computed tomography-guided, trans-thoracic percutaneous lung biopsy


  3rd Scientific Session Top


Twenty years of transfontanelle ultrasound scanning in the West African sub-region

Donald A Nzeh


Department of Radiology, University of Ilorin Teaching Hospital, Ilorin, Nigeria

Correspondence: Prof. Donald A Nzeh,

University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria.

E-mail: donald_nzeh@yahoo.com

ABSTRACT

Objective:
Premature infants are prone to some diseases in the brain such as intracranial haemorrhage (ICH) and periventricular leukomalacia (PVL). Babies who are born at term can suffer from birth asphyxia. In addition, a baby can be born with congenital malformation of the brain. Occasionally, primitive tumours and cystic lesions of the brain may be encountered. Diseases of the brain are readily diagnosed using transfontanelle ultrasound (US). US as an imaging tool is beneficial because it is simple to operate, affordable, readily available and has a high diagnostic yield. This imaging modality was first performed in West Africa at the University of Ilorin Teaching Hospital, Ilorin, Nigeria in 1992 and has become well established in the last 20 years. Materials and Methods: A sector probe with small footprint that fits readily into the anterior fontanelle and has a wide angle beam is usually chosen for the examination for optimum visualization of the brain. For premature infants with small heads, the probe frequency used is normally 5.0-7.5 MHz. Mature heads in older infants, or infants with large heads as in hydrocephalus need lower frequency transducer in the range of 3.5 MHz for deeper penetration. The anterior fontanelle serves as an acoustic window to perform US brain scans prior to its closure at 18 months although it may remain open up till about 30 months in children with severe hydrocephalus. Results: US was be used to demonstrate a wide range of diseases like ICH, PVL, meningitis, hydrocephalus from cerebral aqueduct stenosis and tumours in less than 5 min by experienced sonologists. Conclusion: Transfontanelle US is an affordable, safe and readily available imaging modality for evaluation of the infant brain. It should serve as the first-line investigation to evaluate the infant brain in non-traumatic disease conditions.

Key words: Trans-fontanelle ultrasound, West Africa

Reference centile charts for ratio of foetal trans-cerebellar diameter to abdominal circumference in a Nigerian population

Cecils O Maduforo, Nelson C Nwankwo, Chinwe R Onwuchekwa


Department of Radiology, University of Port Harcourt Teaching Hospital, Port Harcourt, River State, Nigeria

Correspondence: Dr. Cecils O Maduforo,

Department of Radiology, University of Port Harcourt Teaching Hospital, Port Harcourt, River State, Nigeria.

E-mail: gcecilsmaduforo@yahoo.com

ABSTRACT

Aim:
To establish the centile chart for the ratio of transverse cerebeller diameter to abdominal circumference (TCD/AC) from 13 weeks to 40 weeks gestation period. Materials and Methods: A total of 373 normal pregnant women were recruited in this study. Exclusion criteria included uncertain LMP, multiple gestation, foetal abnomalies any maternal conditions which could influence foetal growth. TCD/AC of all the clients foetuses were measured by out by gestation age. The mean and standard deviation of TCD/AC ratio were estimated at each week of gestation-the 5 th , 10 th , 50 th , 90 th and 95 th percentile were calculated at each week of gestation. Results: Of the 333 pregnant women 50 (15.5%) were scanned before 20 weeks gestation and 154 (46.2%) were scanned between 20 weeks and 30 weeks of gestation. 134 (40%) were scanned after 30 weeks gestation TCD/AC ratio declined from early pregnancy until about 20 weeks then remained stable. After 30 weeks of gestation it started to decrease again. Conclusion: The normal reference value of TCD/AC ratio in Nigeria foetus were shown in this study. This ratio will be useful in calculating gestational age in intrauterine growth restricted foetus.

Key words: Abdominal circumference, foetal, trans-cerebellar diameter

Ultrasound-guided Tru-cut biopsy of the breast: The initial experience

Millicent O Obajimi, Adenike T Adeniji-Sofoluwe, Temitope O Soyemi, Abideen O Oluwasola 1 , Adefemi Afolabi 2 , Idayat A Ogungbade


Departments of Radiology, 1 Pathology and 2 Surgery, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria

Correspondence: Prof. Obajimi Millicent O,

Department of Radiology, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria. E-mail: millieobaj@yahoo.com

ABSTRACT

Background:
Ultrasound-guided Tru-cut biopsy is one of the recent advances in the management of breast cancer. It is a work up procedure in women with suspicious breast lesion. It is convenient, prompt and easily accessible. Materials and Methods: This is a prospective study of 34 biopsies carried out from 2009 to March 2012 in the Department of Radiology. It is an ultrasound guided procedure using the manual spring-loaded core-biopsy gun. Thereafter, core specimens are sent for histology and immuno-histochemistry. Results: Histology showed 29.4% benign and 70.6% malignant lesions. Among the malignant lesions, invasive ductal carcinomas were predominant, accounting for 87.5% while intra-ductal carcinomas, invasive lobular carcinomas and secretory carcinomas occurred in 4.2% each. Immuno-histochemistry report was available in 62.5% of the malignant lesions and triple negativity was seen in 60% of these. Fibrocystic changes were reported in 63.6% of the benign lesions. Conclusion: Ultrasound-guided Tru-cut needle biopsy is a well tolerated and reliable procedure for evaluating a breast mass suspicious of malignancy. It provides tissue diagnosis before definitive treatment and obviates the need for excision biopsy of lesions. Despite its advantages, it is expensive to carry it out in the developing world.

Key words: Breast, ultrasound-guided Tru-cut biopsy

Radiculopathy: An unusual presentation of leiomyoma uteri in a young woman

Nneka I Iloanusi, Ijeoma V Ezeome 1 , Philip C Okere


Departments of Radiation Medicine, 1 Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria

Correspondence: Dr. Nneka I Iloanusi,

Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria. E-mail: nnekailoanusi@gmail.com

ABSTRACT

Objective:
To present an unusual case of leiomyoma uteri presenting with radiculopathy in a 37 year-old nulliparous woman. Materials and Methods: Retrospective review of the patient's hospital records. History: A 37-year-old nulliparous woman with no previous history of ill-health presented with worsening symptoms of radiculopathy involving the right lower limb. Plain radiographs of the lumbo-sacral spine showed no evidence of spondylosis or spondylolisthesis. Further imaging magnetic resonance imaging (MRI) and Ultrasonography (USS) revealed a large uterus riddled with multiple multi-compartment fibroids of various sizes with a large posteriorly-located pedunculated component which filled the pre-sacral space, displaced slightly to the right and exerting mass effect on the lower sigmoid colon and sacrum. Intervention: Patient opted for total abdominal hysterectomy. Post-operatively, the patient confirmed marked relief of symptoms of radiculopathy. The patient was discharged without complications and remains largely symptom-free. Conclusion: A posteriorly-displaced leiomyoma of the uterus can cause radiculopathy. Excision of this mass offers relief. Cross-sectional imaging plays a role in diagnosis and guiding further surgical management.

Key words: Leiomyoma, radiculopathy, pedunculated fibroid

Paediatric computed tomography at Aminu Kano Teaching Hospital, Kano Nigeria

Anas Ismail, Muhammed A Suwaid


Department of Radiology, Aminu Kano Teaching Hosptal, Kano, Nigeria

Correspondence: Dr. Anas Ismail,

Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria. E-mail: ibnmalikanas@yahoo.co.uk

ABSTRACT

Background:
Computed tomography (CT) is becoming popular with advancing technology. Paediatirc imaging is also affected by this trend. This study determines the pattern of paediatric CT scanning practice and common findings at Aminu Kano Teaching Hospital. Materials and Methods: Patients aged between 2 days to 14 years examined with four-slice Bright speed CT scanner at radiology department, over 12 month period were reviewed. Information concerning the age, gender indications for the CT scan, type of CT scan conducted and findings were recorded. Results: One hundred and forty children were reviewed, consisting of 80 boys and 60 girls. Their ages range from 0.01 years to 14.0 years, with mean of 5.64 ± 4.31. Brain scan is the most commonly performed (88.8%) while abdominal consist of 4.9%. The most common indication for CT examination in these subjects is convulsion (21.43%), followed by trauma (15.71%) and progressive head enlargement (11.43%). About 29.2% of the scans were normal while obstructive hydrocephalus constitutes 13.2%. General brain atrophy constitutes 9.1%. nephroblastoma and posterior fossa masses constituted 2.1% and 2.0% respectively. Conclusion: This review shows predominance of brain CT scan in children, with seizures and trauma being the most common indications. Obstructive hydrocephalus, brain infarction and general atrophy dominate the findings. Presence of global atrophy in some of the patients is worrisome as it will adversely affect the prognosis.

Key words: Abdomen, brain, children, computed tomography scan, hydrocephalus


  4th Scientific Session Top


Ultrasonographic measurement of the normal portal vein diameter in Nigerian adults

SO Ukperi, Abiodun O Adeyinka 1 , CC Achebe, F Anor 1


Federal Medical Centre, Ido-Ekiti, Ekiti, 1 University College Hospital, Ibadan, Oyo, Nigeria

Correspondence: Dr. Abiodun O Adeyinka,

Department of Radiology, University College Hospital, Ibadan, Oyo State, Nigeria. E-mail: ddotun2003@yahoo.com

ABSTRACT

Background:
Portal vein diameter is a valuable diagnostic parameter in pathologies involving the hepatobiliary system (portal hypertension, liver cirrhosis, portal vein aneurysm and thromboses etc). Aim: The main purpose of this study is to determine the trans-abdominal ultrasonographic diameter of normal main portal vein among adult Nigerians, which may serve as base-line measures in this environment. Materials and Methods: This is a cross-sectional study involving 400 subjects between 18 years to 90 years. Measurements of the portal vein were taken at its broadest point just distal to the union of the splenic and superior mesenteric veins in the region of the porta hepatis. The transverse diameter was obtained with patient lying supine in the right anterior oblique position in relation to the sound beam with 15°-40° of obliquity. Results: The mean transverse portal vein diameter obtained was 8.0-0.12 mm. The extremes ranged between 5 mm to 12 mm. Conclusion: Reference values have been established for the portal vein in this sub-region of Nigeria, which can be used for the diagnosis of portal hypertension and other pathologies affecting the portal venous system. The values obtained in this study are comparable to that found in other studies in Caucasians and Africans.

Key words: Portal Vein diameter, abdominal ultrasound, Nigerians

Cranial CT findings in head injured patients during communal/ethno-religious crisis: Jos experience

Charles Chibunna Ani, Stephen Daniel Pam, John Ekene Ekedigwe, Samson Omini Paulinus


Department of Radiology, Jos University Teaching Hospital, Jos, Nigeria

Correspondence: Dr. Charles Chibunna Ani,

Department of Radiology, Jos University Teaching Hospital, Jos, Nigeria. E-mail: dranicharles@yahoo.com

ABSTRACT

Background:
Communal/ethno-religious crisis have been on the increase in our part of the world with attendant morbidity and mortality. Assailants often target the head of their victims intent on causing mortal harm. Assault objects include knife, club, matchet, gun and more recently improvised explosive device. Computed tomography (CT) scan is effective in demonstrating soft tissue and bony injuries. Our experience in Jos, Nigeria underscores the relevance of documentation of imaging findings on patients who presented following such crises. Objective: To profile the findings on cranial CT scan of patients with head injury during communal/ethno religious crisis in Jos, Plateau State, Nigeria. Materials and Methods: Retrospective and prospective evaluation of cranial CT scan conducted on 43 victims of communal/ethno-religious crisis between January 2010 and March 2012 was carried out in the CT suite of Radiology Department, Jos University Teaching Hospital, Jos. Results: Of the 43 patients, 37 were male and 6 were female (male-female ratio of 6:1). The ages of the patients ranged from <1 year to 80 years. The mean age of the patients was 36.7 years. Abnormal CT finding were seen in 37 patients (86.1%) while 6 patients (13.9%) had normal scan. The most common CT scan findings were intra-cerebral contusion (51.1%), skull fracture (48.8%), and subdural hematoma (23.2%). Head injury was inflicted mostly by matchet cut. Conclusion: The high prevalence of head trauma during communal/ethno-religious crisis justifies the use of CT scan in investigating the nature of head injury to affected victims as well as provide an invaluable guide for their prompt management.

Key words: Computerized Tomography scan, communal crisis, head injury

Ductal carcinoma in situ of the breast: Mammographic and histologic correlations

Cecils O Maduforo, Christopher Chinedu Obiorah 1


Departments of Radiology, 1 Anatomical Pathology, University of Portharcourt Teaching Hospital/College of Health Sciences, University of Port Harcourt, Rivers State, Nigeria

Correspondence: Dr. Cecils Obinna Maduforo,

Department of Radiology, University of Port Harcourt Teaching Hospital, Port Harcourt, River State, Nigeria.

E-mail: gcecilsmaduforo@yahoo.com

ABSTRACT

Aim:
To determine how the predominant type calcification on mammogram correlates with the predominant tumour subtype; a knowledge that would assist in the development of clinical criteria for selection of patients for appropriate management protocol. Materials and Methods: A retrospective study of 93 consecutive cases of ductal carcinoma in situ (DCIS). Microcalcifications were categorized as predominantly linear or granular and were correlated with the predominant histologic subtype of DCIS of the tissue containing the calcifications seen on mammograms. Results: Linear calcifications were present in 44% (16/36) ductal commedocarcinomas in situ compared to 17% (4/24) of cribriform, solid or papillary subtypes (P = 0.01). Granular calcifications were mostly present in 53% (20/36) of comedocarcinomas compared to 83% (20/24) of non-comedo types (P = 0.01). In 88% (15/17) of cribriform DCIS, granular microcalcifications were seen in mammograms. 80% (16/20) of linear calcifications were associated with comedo type while 50% (20/40) of granular calcifications were associated with non-comedo subtypes. Conclusion: Comedo subtype is more likely to be associated with linear calcifications and non-comedo subtype with granular calcifications. However, the predominant subtype cannot be predicted with high degree of accuracy on the basis of the type of microcalcification alone.

Key words: Ductal Carcinoma in situ, mammographic features, histological correlation

Transrectal prostate cancer evaluation: gray-scale and Doppler sonography

Chinwe R Onwuchekwa, ON Ekeke 1 , Cecils O Maduforo, OS Alasia, AF Abuwa


Departments of Radiology, 1 Surgery, University of Port Harcourt Teaching Hospital (UPTH), Port-Harcourt Rivers State, Nigeria

Correspondence: Dr. Chinwe R Onwuchekwa,

Department of Radiology, University of Port Harcourt Teaching Hospital, Port Harcourt, River State, Nigeria.

E-mail: chichekwas2003@yahoo.com

ABSTRACT

Background:
Prostate carcinoma is a pervasive disease affecting a large percentage of men over the age of 50. The incidence of significant disease and mortality are increasing. Transrectal sonography is one of the most sensitive techniques to evaluate prostatic disease. Materials and Methods: A total of 46 men underwent transrectal sonography of the prostate. Subjects were examined in the left lateral decubitus position using a high frequency endorectal sector probe. No preliminary patient preparation was required. No complications were encountered. The characteristics of the prostate and abnormal focus were evaluated. Results: There were 11 pathologically proved cancers and 35 cases of benign prostatic disease. The capsule was smooth and regular in 30 cases of benign prostates and in nine men with cancer. Capsular irregularity was present in five of benign prostates and in two men with cancer. These two cases have capsular invasion. The abnormal focus evaluation reveals that most of the abnormal focus was hypoechoic. 20% of the abnormal focus has irregular margin. Seven of the cancer cases show a localized increased flow with low resistive index, while there was generalized increase flow in three cases. One case of cancer showed absent color flow 20 of the benign lesions show generalized increased color flow while there was localized increased flow in 11 and normal flow in five cases. Conclusions: Real time ultrasound is valuable in detecting lesions not palpable at digital rectal examination; a combination with Doppler scan increases the sensitivity of ultrasound in lesion detection and in differentiation of benign from malignant lesions.

Key words: Prostate carcinoma, trans-rectal ultrasound, digital rectal examination

Chest radiographic pattern of human immunodeficiency virus infection Sokoto, North Western Nigeria

Sule Ahmed Saidu, Aliyu Muhammed Makusidi 1 , Chibueze Haggai Njoku 1


Departments of Radiology, 1 Medicine, Usmanu Danfodiyo, University Teaching Hospital, Sokoto, Nigeria

Correspondence: Dr. Sule Ahmed Saidu,

Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, North Western, Nigeria. E-mail: sulesaidu@yahoo.com

ABSTRACT

Background
and Aim: Chest infection is the commonest clinical presentation following suppression of immunity by human immunodeficiency virus (HIV) infection. This infection can range from recurrent community acquired pneumonia, atypical pneumonia, to pulmonary tuberculosis (PTB) which may develop at any stage of the HIV infection. The global epidemic of HIV/acquired immunodeficiency syndrome has infact led to a resurgence in the prevalence of PTB. The foregoing therefore, underscores the need for routine chest radiography among HIV infected patients. Materials and Methods: This is a cross-sectional prospective study of the chest radiographic pattern of 150 consecutive confirmed HIV-seropositive patients undertaken between 1 st September 2005 and 31 st August, 2007. The socio-demographic and clinical features were obtained and the chest radiographs were evaluated for any feature considered pathological or otherwise. Data were subsequently analysed using SPSS 11.0. Results: The mean age was 31.86 (±15.57) years and there were 116 males and 34 females. Majority (90%) of the patients were married. Driving was the commonest occupation followed by military/paramilitary vocation while students were the least affected. The predominant clinical manifestations were productive cough (100%) and weight loss (91%) while 7% of the patients had Herpses zoster. The commonest radiographic features were patchy/streaky opacities and cavitatory lesions in 40% and 25% of the patients respectively. Nine percent (9%) of the patients had normal chest radiographs. Conclusion: Various chest radiographic findings were found in HIV infected individuals, with patchy streaky opacities being the commonest. A normal chest radiograph should not be totally unexpected in such patients.

Key words: Chest radiographic pattern, HIV infection, chest infections


  5th Scientific Session Top


Paediatric computed tomography at Aminu Kano Teaching Hospital, Kano Nigeria

Anas Ismail, Muhammed A Suwaid


Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria

Correspondence: Dr. Anas Ismail,

Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria. E-mail: ibnmalikanas@yahoo.co.uk

ABSTRACT

Background:
Computed tomography (CT) is becoming popular with advancing technology. Paediatirc imaging is also affected by this trend. This study determines the pattern of paediatric CT scanning practice and common findings at Aminu Kano Teaching Hospital. Materials and Methods: Patients aged between 2 days to 14 years examined with four-slice Bright speed CT scanner at radiology department, over 12 month period were reviewed. Information concerning the age, gender indications for the CT scan, type of CT scan conducted and findings were recorded. Results: One hundred and forty children were reviewed, consisting of 80 boys and 60 girls. Their ages range from 0.01 years to 14.0 years, with mean of 5.64 ± 4.31. Brain scan is the most commonly performed (88.8%) while abdominal consist of 4.9%. The most common indication for CT examination in these subjects is convulsion (21.43%), followed by trauma (15.71%) and progressive head enlargement (11.43%). About 29.2% of the scans were normal while obstructive hydrocephalus constitutes 13.2%. General brain atrophy constitutes 9.1%. nephroblastoma and posterior fossa masses constituted 2.1% and 2.0% respectively. Conclusion: This review shows predominance of brain CT scan in children, with seizures and trauma being the most common indications. Obstructive hydrocephalus, brain infarction and general atrophy dominate the findings. Presence of global atrophy in some of the patients is worrisome as it will adversely affect the prognosis.

Key words: Abdomen, brain, children, computed tomography scan, hydrocephalus

African male breast cancer in Northwestern Nigeria

David Ayorinde Dawotola, Vincent Isebor Odigie 1 , Lazarus MD Yusufu 1 , Adamu Abdullahi, Oiza Thereza Ahmadu


Radiotherapy and Oncology Centre, 1 Breast And Endocrine Unit, Division of General Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Correspondence: Dr. David A Dawotola,

Department of Radiotherapy and Oncology Centre, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. E-mail: david_dawotola@yahoo.com

ABSTRACT

Purpose:
This communication is to share our experience in the management of male breast cancer in North Western Nigeria. Male breast cancer is rare worldwide, accounting for about 1% of all breast cancers. Presentation in lesser developed countries is late because of ignorance of the disease. Management in less developed countries is a challenge to practicing oncologists because of limitation of resources. Materials and Methods: All consecutive males with histologically proven breast cancer were prospectively studied, between 2006 and 2010 (5 years), via a proforma. Main modalities for treatment include surgery, radiotherapy and hormone treatment by orchidectomy. Results: There were seven cases, constituting about 0.87% of all breast cancer cases seen within the study period. The age range was 32-80 years; the mean age was 49.6 years. More than one-half were of low socio-economic class. Knowledge of the disease was extremely limited among the patients studied. Duration of symptoms was from 6 months to 60 months, with a mean of 35.7 months. All patients presented with a breast lump, ulceration was quite common (85.7%). Almost 3 out of four patients (71.4%) had evidence of distant metastases (lungs and vertebral spine were the most common), while 28.6% had locally advanced disease. All were Invasive Ductal Carcinoma. No patient consented to orchidectomy. Mortality was high. Survival at 14 months was 14.8%. Conclusion : Male breast cancer is rare in this sub region and presentation is late. Patients' awareness of disease may reduce the prevalence of late presentation (advanced disease).

Key words: African, Male breast cancer, North-Western Nigeria

Introducing the Fibroscan: Transient elastography of the liver

Charles C Ani


Department of Radiology, Jos University Teaching Hospital, Jos, Nigeria

Correspondence: Dr. Charles C Ani,

Department of Radiology, Jos University Teaching Hospital, Jos, Nigeria.

E-mail: dranicharles@yahoo.com

ABSTRACT

The extent or progress of fibrotic change within the liver often reflects the severity of liver disease. Its determination is important in clinical practice and its response to treatment can be predicted. Until now, percutaneous liver biopsy is widely considered the diagnostic gold standard for grading and staging of liver disease. However, liver biopsy is an invasive procedure with certain avoidable risks and complications. Several methods have been studied in an attempt to reach a diagnosis of cirrhosis by non-invasive means. Fibroscan (transient elastograghy of the liver) has been designed to quantify liver fibrosis by means of elastography and was found to have reasonably good sensitivity and specificity patterns, especially in patients with advanced fibrosis, and it can be used as an alternative to liver biopsy. Transient elastography is based on measurement of the elasticity (stiffness) of the liver using ultrasound. This new method is painless and provides a particular benefit for populations at risk, including hemophiliacs, transplant patients, and those who refuse biopsy.

Key words: Fibroscan, transient elastography, chronic liver disease

Pattern of gynaecological malignancies seen from 2006-2011

Sunday Adeyemi Adewuyi, Adekunle Olanrewaju Oguntayo 1 , Abimbola Omolara Kolawole 1 , Modupeola Omotara Samaila 2


Departments of Radiotherapy and Oncology, 1 Obstetrics and Gynaecology, 2 Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Correspondence: Dr. Sunday Adeyemi Adewuyi,

Department of Radiotherapy and Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. E-mail: sadewuyi2003@yahoo.com

ABSTRACT

Objective:
To evaluate the pattern of gynaecological malignancies seen in a major referral tertiary health institution in Northern Nigeria. Materials and Methods: Between January 2006 and December 2011, a period of 6 years, a total of 1130 new patients (both male and females) were seen of which 350 (31%) consecutive patients with histologically confirmed gynaecological malignancies were studied retrospectively and evaluated with respect to age at presentation, organ of origin, stage of disease and retroviral status irrespective of social status, performance status and histologic type. Paediatrics patients (<14 years) and patients with benign or premalignant conditions were excluded from the study. Patient's folders were reviewed retrospectively with a structured pro forma. Results were analyzed using Epi Info software 3.4.1; 2007 edition. Results: A total of 350 patients were having gynaecological malignancies. The age range was 21-86 years, with mean age of 49.24 years and a modal age group of 41-50 years, median age of 50 years. The commonest gynaecological malignancy seen was cervical cancer which accounted for 286 (81.7%) followed by ovarian epithelial cancer 21 (6%), endometrial cancers 14 (4%), ovarian germ cell tumours 9 (2.6%), vagina 8 (2.3%), vulva 8 (2.3%) and 2 (0.6%) patients with gestational trophoblastic disease and myometrial sarcoma respectively. Most patients 298 (85.1%) had locally advanced disease, 33 (9.4%) with metastatic disease and only 19 (5.4%) had early stage disease at presentation. Human immunodeficiency virus (HIV) seropositive was seen in 36 (10.3%) patients with cervical cancer accounting for 34 (9.7%) patients and one patient each with ovarian germ cell tumour and vaginal cancer. Conclusion: The peak modal age group for gynaecological malignancies is the 5 th decades of life. Cervical cancer is the commonest gynaecological malignancy seen in the study environment, and locally advanced disease is the predominant stage at presentation. Cervical cancer is the predominant malignancy seen in HIV positive patients with gynaecological malignancies.

Key words: Gynaecological malignancies, pattern of cancers, tertiary health institution

Pattern of chest radiographic findings in sputum smear positive pulmonary tuberculosis patients as seen in Sokoto

Suleiman A Saidu, Aliyu Muhammed Makusidi 1 , Chibueze Haggai Njoku 1


Departments of Radiology, 1 Medicine, UDUTH, Sokoto, Nigeria

Correspondence: Dr. Suleiman A Saidu,

Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. E-mail: sulesaidu@yahoo.com

ABSTRACT

Background
and Aim: Pulmonary tuberculosis has become a major public health concern particularly with the global human immunodeficiency virus (HIV) acquired immunodeficiency syndrome epidemic. More than 9 million people are diagnosed with active tuberculosis each year, and 1.6 million die of the disease. Recent report has shown that the disease affects mainly young adults in their most productive age with attendant socio-economic impacts on the nation. Though, sputum bacteriology study is the gold standard in making the diagnosis of PTB, however, chest radiograph has served as an important investigation stool in the management of PTB cases. In fact in certain clinical conditions, a tentative diagnosis of PTB is made based on clinical and radiological features even if the sputum smear is negative. It is on this background that we evaluated the chest radiograph of our PTB cases. Materials and Methods: This is a prospective 2 year study undertaking between January 2007 and December 2008 among treatment naïve sputum smear positive PTB patient who had chest radiography at the time of diagnosis. The socio-demographic and clinical features were recorded. The chest radiograph was reported by one of the author and the data was analysed. Results: One hundred and six consecutive cases of PTB patient who had chest radiograph done at our centre were recruited in his study. Their age range was 20-75 years with mean (±SD) of 37.1 (±10.3) years. There were 78 males (73.6%) and majority of the patients 92 (86.8%) were married. A significant proportion (54%) of cases are of low socio-economic status. About 52% of cases were HIV positive while 3 of the HIV negative were diabetics. The commonest presenting clinical features are fever (100%), productive cough (100%), chest pain (95%), weight loss (91%) and drenching night sweat (65%). The radiographic findings were patchy/streaky opacities in 58 patients, cavitatory lesion in 46 patients, reticulo-nodular opacities and pneumonic consolidation were found in 19 patients each. Eight cases had plural effusion, lung collapse was found in four cases. Bilateral affection of the lung fields was commonest in 68.3% and upper lobe affectation is the commonest finding in 78.2%. Conclusion: Patch/streaky opacities and cavitatory lesions are the commonest chest radiographic findings in PTB cases in our study.

Key words: Chest radiographic findings, pulmonary tuberculosis, sputum smear-positive

A riddle on a patient with obstructive jaundice and hepatic encephalopathy solved by post mortem examination and histology: Urgent reawakening for the obvious request

Samuel O Ola, Abideen O Oluwasola 1 , Godwin I Ogbole 2 , Adegboyega Akere 2 , Ademola J Adekanmi 2 , AA Salami


Department of Medicine, 1 Morbid Pathology and 2 Radiology, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria

Correspondence: Dr. Samuel O Ola,

Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria. E-mail:soola2001@yahoo.com

ABSTRACT

Introduction:


Obstructive Jaundice

  • Intrahepatic - hepatitis
  • Liver cirrhosis
  • Primary hepatocellular
  • Carcinoma
  • Extrahepatic-gallstones, tumours, parasites, inflammation of the bile ducts, and fibrotic strictures secondary to traumatic injury,
  • Intraductal or extraductal is uncommonly associated with widespread liver involvement and hepatic encephalopathy. Such occurrence calls for a definite search for the pathology
  • Investigatory modalities - Biochemical studies-stool, urinalysis
  • BC, Film appearance/genotype
  • Electrolyte, urea, creatinine
  • Tumour markers.
AFP, CEA and CA19-9

  • A routine chest radiograph
  • Abomino-pelvic ultraound/computerised tomography (CT)/magnetic resonance imaging
  • Endoscopic ultrasonography
  • Cholangiography, via a percutaneous route, or endoscopic retrograde cholangiopancreato graphy
  • Coeliac angiography
  • Laparascopy
  • Laparatomy
  • Pathology-post mortem
  • Examination to resolve the quandary.
Case Presentation:

  • A 65-year-old woman, retired health worker from a Nigerian hospital,
  • Known Hypertensive ×20 years and diabetes mellitus (DM) X 1/12
  • 4/52 history of fever, generalized body weakness, yellowness of eyes, coke-coloured urine, anorexia and haematochezia
  • Genotype AA, febrile, obese, icteric hepatomegaly (16 cm) and infected sacral ulcer.
Clinical Diagnosis:

  • Obstructive Jaundice? Cause with hepatic encephalopathy, sepsis, hypertensive heart disease, diabetes mellitus and upper GIT Bleeding
  • Carcinoma of pancreas
  • Cholangiocarcinoma
  • Hepatocellular carcinoma
  • Carcinoma of Gallbladder.
Dilemma surrounding the analysis on her presentation - further investigations

Radiology and Pathology (a post-mortem examination - very poor) Managed conservatively till her exitus.

Investigations - Radiology:

  • Abdominal ultrasound scan showed hepatomegaly with coarse heterogenous echoes, periportal and para-aortic lymphadenopathy, complex right renal cysts and cholelithiasis
  • Ca Gallbladder gall stone thickened wall.


Abdomino-pelvic CT:

  • Multiple ill-defined hepatic masses intrahepatic biliary obstruction, para-aortic lymphadenopathy, masses at the porta hepatis
  • Normal pancreas with a fairly rounded hypo-dense mass at the pancreatic head suggestive of a necrotic lymph node,
  • Well-distended gallbladder with a thickened wall (5.3 mm) but NO gall stones
  • Bilateral pleural thickening posteriorly in both lung bases, destroyed L2 vertebral body, right simple renal cyst, multiple vascular atheromatous plaques and thoracolumbar spondylosis Suggestive of hepatic metastases and L2 vertebral body metastases from an unknown primary site with differentials such as Breast, thyroid and possibly a periductal carcinoma of the pancreas.
Post mortem findings-1:

  • Limited autopsy performed
  • The peritoneal cavity contains about 1000 ml of bile stained fluid
  • The liver is enlarged and weighs 2845 g
  • Shows multiple greyish white tumour nodules
  • The gallbladder is markedly distended and cut surface shows a patent lumen containing bile and a single large cholesterol stone measuring 5 cm in diameter
  • The wall of the gallbladder is thickened and shows multiple greyish white nodules
  • The gallbladder bed also has multiple tumour nodules
  • The Pancreas shows normal yellowish lobulation
  • The spleen is diffluent
  • Calculous cholecystitis
  • Histology was performed.
Final anatomic diagnosis:

  • Carcinoma of the gallbladder with background Calculous cholecystitis and liver metastasis.
Discussion:

  • Clinical presentation of hepato - biliary involvement with hepatic decompensation-bilirubilinaemia, ascites, coagulopathy and encephalothy. Raised CEA and AFP
  • Co-morbidity, hypertensio, DM, anaemia and sepsis
  • Raised transaminases, alkaline phosphatases, AFP and CEA
  • Limitation of ultrasonograhy - missed hepatic masses, posterior abdominal wall masses, pancreatic head mass and gave gall bladder wall thickening as cholelithiasis
  • CT difficulty in interpreting findings - identified a fairly rounded hypodense mass at the pancreatic head suggestive of a necrotic lymph node and well-distended gallbladder with a thickened wall (5.3 mm) but no mention of tumour of gallbladder
  • Pathology - Post mortem examination though a nearly dead medical court of appeal in Nigerian hospitals is a useful asset in resolution of the dilemma in medical practice
  • Advanced disease - tumour 4 node 2 metastasis 2-poor prognosis.
Conclusion:

  • The presentation shows the need for
  • Skilful interpretation of clinical presentations and
  • Report of investigational modalities especially radiology
  • High role of autopsy in making decision in clinical practice
  • Never throw away the water with the baby.
Key words: Investigational studies, post-mortem, radiology, skilful interpretation




 

Top
 
 
  Search
 
Similar in PUBMED
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Address by LOC C...
President's Address
ARAWA Planning C...
1st S...
2nd S...
3rd S...
4th S...
5th S...

 Article Access Statistics
    Viewed7943    
    Printed93    
    Emailed0    
    PDF Downloaded21    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]