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   Table of Contents - Current issue
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July-December 2018
Volume 25 | Issue 2
Page Nos. 85-140

Online since Tuesday, July 17, 2018

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ORIGINAL ARTICLES  

Prevalence of ultrasound-diagnosed asymptomatic simple renal cysts at the University College Hospital, Ibadan p. 85
Janet Akinmoladun, August Takure, Olanrewaju Ogunleye
DOI:10.4103/wajr.wajr_58_17  
Background: Renal cysts are thin-walled sacs of fluid that form within the renal parenchyma which may be simple or complex. Most simple renal cysts are asymptomatic and are found usually incidentally by ultrasonography and computed tomography. However, a small proportion may become symptomatic with pain being the most common symptom. The aim of the study is to determine the prevalence of asymptomatic simple renal cysts in patients presenting for abdominal ultrasound(US) and the associations of simple renal cysts with age and gender. Materials and Methods: This was a retrospective study which involved the retrieval of the results of abdominal US performed at the Radiology Department of the University College Hospital between January 2013 and December 2015. Data extracted included age, sex, and renal sonographic findings. The retrieved data were analyzed using Statistical Package for the Social Sciences(SPSS) version20.0 software. Results: Two thousand and ninety-five patients had abdominal US done during the study period. The overall prevalence of asymptomatic simple renal cysts was 2.3% with the prevalence increasing with age(P<0.001). Simple renal cysts were found in 2.3% of both males and females with a male-to-female ratio of 1:1.3. The mean widest diameter of renal cysts was 45mm with a range between 15 mm and 105mm. The cyst diameter tended to increase with age, but the correlation with age was not statistically significant(P=0.278). The majority of the cysts were solitary(87.8%) with the right kidney having majority(59.2%) of the cysts. Conclusion: The overall prevalence of simple renal cyst in our study is 2.3% and it increased with age. Since simple renal cysts have been associated with some conditions and complications such as hypertension, polycythemia, hemorrhagic transformation, and cyst rupture, adequate follow-up is necessary to enable the prompt detection of complications and adequate intervention if the need arises.
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Distensibility coefficient of the common carotid artery in acute cerebral infarct by M-mode ultrasound: Across-sectional study p. 90
Vishwanath T Thimmaiah, C Anupama
DOI:10.4103/wajr.wajr_23_17  
Introduction: Distensibility coefficient(DC) is abnormal in most cases of acute cerebral infarct patients. Intima-media thickness(IMT) is measured by B(brightness)-mode and distensibility by M(motion)-mode ultrasound. DC is not routinely measured in clinical practice even though it is the earliest functional change to occur in common carotid arteries. IMT represents structural change and DC represents functional changes that occur in common carotid. Aim: DC is a valid independent indicator for risk assessment of acute cerebral infarcts. The present study is aimed at knowing the association of abnormal DC with acute cerebral infarct patients. Materials and Methods: Cross sectional study was undertaken over a period of 9 months with 210 cases of acute cerebral infarct. Distensibility of common carotid artery was measured by M-mode ultrasound. Cramer's V value ranged from 0.0 to 1.0 and P <0.05 was considered statistically significant. Results: DC was reduced in 62.8% of the total 210cases of acute cerebral infarct. Maximum cases(38%) were in the age groups of 61–70years. Cramer's V value ranged from<15 to<24×10−3 kPa (P < 0.001). There was a good association between reduced DC and acute cerebral infarct in the present study. Conclusion: DC is a valid independent risk factor for acute cerebral infarct. DC represents functional vessel wall property and decreases with age. M-mode-derived measurements for DC are valid, and abnormal DC value is associated well with acute cerebral infarct.
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Radiobiological estimation of radiation-induced heart complication of postmastectomy radiation therapy patients using the relative seriality model p. 95
Folajimi Oludare Adeyemi, Enosakhare Godwin Okungbowa
DOI:10.4103/wajr.wajr_59_17  
Background and Aim: In Nigeria today, most radiotherapy (RT) centers do manual planning using anatomical landmarks rather than precise planning using imaging modalities such as Computerized Tomography and Magnetic Resonance Imaging. This puts the collateral organs at a greater risk of damage. The objective of this study is to carry out a comparison of the risk of cardiac complication in the right and left breasts of postmastectomy radiation therapy patients using radiobiological evaluation tools. Methods: Ninety-six patients treated in the University of Benin Teaching Hospital, RT Center, Nigeria, between January 2012 and March 2014 were recruited for this study. The relative seriality model was used to compute the risk of cardiac mortality to the breast of these patients. Results: The results showed that the equivalent uniform dose (EUD) to the heart for patients with left breast cancer is significantly (P < 0.05) higher than the EUD to the heart of patients with right breast and also the risk of cardiac mortality is significantly (P < 0.05) higher in the left breast than the right breast; due to proximity to the heart to the left side. Conclusion: This implies that the long-term risk of having cardiac disease should be of particular concern for women treated for left-sided breast cancer. As a result of this, care should be taken in planning patients using computerized treatment planning system that embraces imaging simulation rather than the conventional anatomical landmark; this will go a long way to prevent cardiac-induced mortality especially in cancer of the left breast.
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Diverticulosis among patients referred for barium enema studies at DrGeorge Mukhari Academic Hospital, Ga-Rankuwa, Pretoria, South Africa p. 100
John Osi Ozoh, Gboyega Adebola Ogunbanjo
DOI:10.4103/wajr.wajr_39_17  
Background: Apossible increasing trend in the incidence of diverticulosis was observed in adult patients referred to the Diagnostic Radiology department of DrGeorge Mukhari Academic Hospital(DGMAH), Ga-Rankuwa, Pretoria, for barium enema studies. The study will be the first to document the magnitude of this condition at our hospital since its inception. Objective: The aim of this study is to evaluate the current prevalence of diverticulosis at DGMAH Ga-Rankuwa whose patients are predominantly South Africans of African descent. Materials and Methods: We reviewed the medical records of all adult patients referred to DGMAH for barium enema investigations for 1year. Barium enema studies of 166patients who met the inclusion criteria were systematically evaluated radiologically for the presence of diverticulosis. Data from the records were analyzed using the Statistical Package for Social Sciences(SPSS, version22.0) software program. Results: The patients' ages ranged between 18 and 95years, with a mean age of 60.1years. From the records analyzed, 77.7% were radiologically negative, whereas 22.3% were positive for diverticulosis. There was a female preponderance(23cases[62.2%] among females versus 14cases[37.8%] among males; P <0.0001) and the diverticulosis had a diffused pattern. The increasing trend of diverticulosis observed at DGMAH did not reflect any statistically significant difference when compared with previous studies done in sub-Saharan Africa. Conclusion: This study demonstrates a possible trend of diverticulosis previously unrecorded in barium enema studies at DGMAH, probably attributable to the effects of urbanization and higher consumption of refined carbohydrate with low fiber residue.
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Location of femoral/tibial tunnels in anterior cruciate ligament reconstruction and their impact on graft integrity: Magnetic resonance imaging review p. 106
Sushmita Keerthi Chilkuri, Aji Sam Mathews
DOI:10.4103/wajr.wajr_37_17  
Context: Despite advances in surgical techniques for anterior cruciate ligament(ACL) repair, a significant proportion of patients encounter persisting pain/instability of the knee postoperatively. Objectives: To assess the location of femoral/tibial tunnels on magnetic resonance imaging(MRI) and to correlate the findings with the ACL graft integrity/graft-related complications. Study Design/Settings: This was a cross-sectional study done at Burjeel Medical Centre, Muscat, Oman. Materials and Methods: The study period was between November 2015 and June 2017 on Philips Ingenia 1.5 Tesla MRI machine. Atotal of 30male patients, age ranged from 20 to 43years who presented with knee pain/instability 1year postreconstruction of ACL, were recruited for the study. Results: Of 30cases, 10(33.33%) patients had an intact graft on MRI. Of the remaining 20patients, graft impingement was noted in 15patients(50%), graft tear in 3cases(10%), and graft stretching with abnormal high T2 signal in the remaining 2cases(6.67%). Associated findings of focal arthrofibrosis in the anterior knee joint space and tibial tunnel cysts were encountered in few patients who were not dealt with in this study. Out of 20 patients with graft abnormality, femoral tunnel was abnormally located in 3 (15%), tibial tunnel was located anterior to the MRI equivalent of Blumensaat's extension line partly or completely in 16(80%) and both tunnels were normally located in 1(5%). Conclusion: The location of the femoral/tibial tunnels is the most important determinant factor of postoperative graft integrity in ACL reconstruction patients.
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Thickness and texture of the squamous temporal bone in a Nigerian tertiary hospital p. 112
Richard Busayo Olatunji, Richard C Efidi, Emmanuel E Uko, Ayotunde O Ogunseyinde
DOI:10.4103/wajr.wajr_42_17  
Background: Thickness and texture of the squamous temporal bones(STBs) are the two main patient factors that determine the outcome of transtemporal transcranial Doppler ultrasound. The aim of this study was to determine the thickness and texture of the STB as well as their association with biodemographic characteristics in a tertiary hospital in Southwest Nigeria. Material and Methods: Cranial computed tomography(CT) images of 142 adults acquired on a 64-slice multi-detector Toshiba Aquilion scanner were retrospectively evaluated for the thickness and texture of the bilateral STB at the expected location of the temporal acoustic window on a ClearCanvas® Workstation. Associations of thickness and texture of the STB with biodemographic data were determined by statistical analysis at P <0.05. Results: There were 79male(55.6%) participants and the overall mean age was 51±17.3years(49±16.1years in males and 53.4±18.5years in females). Mean thickness of the 284 STB was 3.21±1.11mm(range 1.2–8.7mm), which was thicker on the left(3.3±1.2mm) than the right(3.1±1.0mm, P =0.001). Thickness of STB showed significant increase(P<0.05) with age on the right(β = 0.23) and left(β = 0.31). Controlling for age, males tend to have thicker STB than females. Thicknesses of STB in 61.3% were favorable for transcranial insonation bilaterally. Homogenous texture was found in 64.8% of STB while the rest were heterogeneous. Acombination of both thickness and texture appear favorable for transcranial insonation in 76.8% of STB evaluated. Conclusion: Thickness of the squamous temporal bone varied significantly with age but not with gender, and the temporal squama were largely of a homogeneous texture. Overall, the important patient factors appear favorable for transtemporal cranial ultrasound in the majority of our participants.
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A comparative ultrasonographic evaluation of intrarenal artery resistive index among hypertensive and normotensive adults in north-western Nigeria p. 118
Ajana George Madubueze
DOI:10.4103/wajr.wajr_34_17  
Introduction: Hypertension is a sustained systolic blood pressure equal to or above 140mmHg or diastolic blood pressure equal to or above 90mmHg. The kidneys play a central role in the control of high blood pressure through the renin–angiotensin system. Thus, renovascular changes of myointimal hyperplasia in the intrarenal arteries may cause an increase in renal arterial impedance and eventually irreversible hypertensive nephropathy. The early detection of these renovascular changes using ultrasonography can provide opportunity for immediate intervention toward preventing or at least delaying the irreversible hypertensive nephropathy. Aims and Objectives: The objective of this study is to determine and compare intra-renal resistive index(RRI) in normotensive and hypertensive adults within the age range of 35–70years at Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: A prospective case–control study of intra-RRI using ultrasound in 150 hypertensive patients and 150 normotensive controls. The mean RRI of the interlobar arteries of both kidneys was measured and recorded. The data were analyzed with the aid of computer-based SPSS 16.0 software for windows. Results: The ages of the study participants ranged between 35 and 70years. The age difference was not statistically significant(P=0.88). The mean interlobar artery resistive index(RI) values were 0.59±0.04 and 0.59±0.03 on the right and left sides, respectively, in normotensive controls while those of hypertensive patients were 0.73±0.03 and 0.73±0.03 for the mean interlobar artery RI values on the right and left sides, respectively, and both were statistically significant. Conclusion: The intra-RRIs were lower in normotensive participants when compared with the hypertensive patients which were statistically significant. These showed that hypertension has significant effects on the kidneys, and with early detection and intervention, irreversible renal damage may be prevented.
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CASE REPORTS Top

Hajdu–Cheney syndrome: Arare acro-osteolytic disorder p. 124
Mojisola Adejoke Olusola-Bello, Ayodeji A Olatunji, Oluyemisi O Toyobo
DOI:10.4103/wajr.wajr_3_18  
We report a case of a 35-year-old woman with Hajdu–Cheney syndrome, a very rare connective tissue disorder with about 70cases reported worldwide since 1948. No similar disease occurred in her family. She presented with clinical features of the syndrome and left seventh cranial nerve palsy after several dental procedures. The radiographs of the skull and the hands demonstrate the abnormalities clearly.
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Nutcracker syndrome presenting as recurrent hematuria p. 127
Blessing Ose-Emenim Igbinedion, Festus Oghanina Ehigiamusoe, Stanley Ngoka
DOI:10.4103/wajr.wajr_45_17  
Nutcracker syndrome(NCS) occurs from compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. It is rare and commonly presents with hematuria, flank pain, and dysuria. A 27-year-old male with sickle cell trait presented with a 9-month history of total hematuria complicated with anemia necessitating blood transfusion. He had no overt signs of urogenital infestation, renal impairment, or trauma. Genotype was AS. Intravenous urography was normal. On cystoscopy, the bleeding was seen to be coming through the left ureteral orifice. Renal angiography showed left renal venous stasis and contrast extravasation into the upper calyces. An impression of NCS was made. Other imaging modalities(computed tomography and ultrasound) supported NCS. NCS should be suspected in cases of recurrent hematuria.
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Unusual sites of intracranial metastases from renal cell carcinoma presenting only with neurological symptoms p. 132
Puneet Garg, Hira Lal, Swapndeep Atwal, Suparva Nayak, Alok K Udiya
DOI:10.4103/wajr.wajr_36_14  
We report a case where patient presented only with neurological symptoms from the metastases of an asymptomatic primary renal cell maligancy , alongwith review of literature for unusual sites of intracranial metastases in the clivus and choroid plexus.
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Further observations on the “spaghetti sign” in upper urinary tract hemorrhage p. 136
Funsho Komolafe, Sabir Hussain, Syed Waqar Hussain
DOI:10.4103/wajr.wajr_49_17  
The “spaghetti sign” is recognized as a radiological sign of upper urinary tract hemorrhage. The sign was first described in the urinary bladder during intravenous urography, but it has subsequently been described on retrograde pyelography and in the urographic phase of contrast CT. We report the observation of the “spaghetti sign” in the bladder on ultrasonography and on Magnetic Resonance Urography (MRU), modalities in which the sign has not been previously described. We suggest that the observations may provide a useful guide when ultrasonography and/or MRU are employed in the search for the source of massive hematuria. We also report two additional cases of hematuria in whom the “spaghetti sign” is demonstrated in the urographic phase of contrast CT.
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