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   2019| January-June  | Volume 26 | Issue 1  
    Online since December 28, 2018

 
 
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ORIGINAL ARTICLES
Cavernosal artery peak systolic velocity among normal adults in Abuja, Nigeria: A Baseline parameter for sonographic diagnosis of vasculogenic erectile dysfunction
Joshua Oluwafemi Aiyekomogbon, Oseremen I Aisuodionoe-Shadrach
January-June 2019, 26(1):9-14
DOI:10.4103/wajr.wajr_50_17  
Background: Erectile dysfunction is consistent inability to achieve and maintain erection of sufficient rigidity for satisfactory sexual performance. It is well known that the hemodynamic function of the penis correlates well with the peak systolic velocity (PSV) of the cavernosal artery (CA) which is the most reliable, sensitive, and objective parameter used in evaluating the state of the erectile tissues of the penis. This study was aimed at establishing the normal CA PSV in this environment, as it may differ from the values among Americans, Caucasians, and Asians. Materials and Methods: The study was conducted between July 2015 and January 2017, at the Department of Radiology, Federal Medical Centre, Abuja. Twenty-nine consecutive patients referred by the urologist to the radiology department of the aforementioned institution for penile ultrasound were evaluated using triplex Doppler sonography with high-frequency linear array transducer. The penile scan was done before and after intracavernosal injection of 10–20 μg prostaglandin E1. The waveforms of CAs were obtained alternately using the angle of inclination ≤60°, and the PSV of the CA was documented at 5-min interval, from 5 to 40 min. Results: PSV of CA varied between 26 and 104.4 cm/s (mean: 46.72 ± 16.21) among the entire research participants. No significant discrepancy was noted between PSV of the right and left cavernosal arteries. The PSV had a strong positive relationship with age (P = 0.002), with the highest values found among those ≤30 years. Conclusion: The mean PSV of cavernosal arteries established in this study is not significantly different from the values obtained among Americans, Caucasians, and Asians, indicating that racial difference has no effect on this important sonographic variable.
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Ultrasound reference values for inferior vena cava diameter and collapsibility index among adult Nigerians
Ademola A Adeyekun, Ogugua Annie Ifijeh, Adenike O Akhigbe, Mohammed Munir Abubakar
January-June 2019, 26(1):25-30
DOI:10.4103/wajr.wajr_51_17  
Background: Correct estimation of intravascular volume is crucial in critically ill and traumatized patients. Measurement of the central venous pressure (CVP) is invasive and time consuming. Studies have shown that inferior vena cava diameter (IVCD) correlates with CVP. Sonographic assessment of IVCD and its respirophasic changes (collapsibility index; CI) is a non-invasive, quick and reliable means of estimating CVP and hence, intravascular fluid volume. Data on such studies are scanty among adult Nigerians. Aim: To establish normograms of IVCD and CI for healthy adults in Benin City, Nigeria as well as determine the relationship of IVCD and CI with height, weight, body mass index (BMI), age and gender. Method: Four hundred apparently healthy adult volunteers were prospectively studied by means of ultrasound. Demographic data and BMI were obtained. The IVCD was measured during inspiration, expiration and sniff. The CI was subsequently calculated for each subject. Statistical Package for the Social Sciences (SPSS) version 17.0 was used for data analysis including tests of significance. Probability values less than or equal to 0.05 were considered significant. Results: The mean IVCD in this study was 6.1±2.2mm and 13.0±4.0 mm for inspiration and expiration respectively. The mean CI was 49.7±0.5%. There was no statistically significant correlation between IVCD and CI with height and BMI. Conclusion: This study has determined normal IVCD and CI reference range for healthy Nigerian adults. The CI is independent of height, weight, BMI and gender. Since the CI is not dependent on physical attributes and gender, it may serve as an objective tool for monitoring the fluid status of patient
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Renal duplex ultrasonography among adult native Nigerian diabetics and diabetic nephropathy population
Sarah Sunday Assenyi, Ademola Joseph Adekanmi, Aarinola Esan
January-June 2019, 26(1):1-8
DOI:10.4103/wajr.wajr_8_18  
Background: Diabetes mellitus (DM) is a serious global health problem with grave socioeconomic impact and debilitating complications especially diabetic nephropathy (DN). This study evaluated the usefulness of renal parenchymal and vascular sonography among three groups-diabetics with nephropathy, diabetes with no evidence of nephropathy and nondiabetics. Materials and Methods: The renal volume, parenchymal changes, and intrarenal vascular indices of three groups of participants (Group A - Diabetic with nephropathy; Group B - diabetic without nephropathy; and Group C - nondiabetic controls) were assessed using B-mode and Duplex ultrasonography. Results: The difference in the means of resistance index (RI) and pulsatility index (PI) in the diabetic patients (Group A and Group B) was significantly higher compared to the controls (RI mean ± standard deviation [SD]: Group A diabetic patients, 0.71 ± 0.11 cm3; Group B diabetics, 0.68 ± 0.08 cm3; controls, 0.62 ± 0.07 cm3; P < 0.0001); (PI ± SD: Group A diabetic patients, 1.22 ± 0.25 cm3; Group B diabetics, 1.16 ± 0.29 cm3; controls, 1.03 ± 0.23 cm3; P = 0.003). The mean renal volume among DM patients (Group A and Group B) were higher than in nondiabetic controls, (mean renal volume ± SD: Group A DM patients with nephropathy, 13.99 ± 3.95 cm3, the diabetic group without DM patients 13.39 ± 4.59 cm3, controls 12.05 ± 3.39 cm3). Conclusion: This study showed that renal RI and PI were significantly increased in patients with diabetes than in healthy controls with a trend of increase from controls to DM without nephropathy to DM with nephropathy. Duplex ultrasonography is useful for the clinical evaluation of diabetes and DN. 13.95 + 7.02% VS 8.20 + 4.19% P = 0.000
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Computed tomographic findings of the brain in adult HIV-infected patients at Doctor George Mukhari Academic Hospital, Ga-Rankuwa, Pretoria, South Africa
John Osi Ozoh, Olakunle Adewunmi Towobola, Gboyega Adebola Ogunbanjo, Evelyn M Kangawaza
January-June 2019, 26(1):15-24
DOI:10.4103/wajr.wajr_48_17  
Background/Aim: The aim of this study is to determine the pattern of computed tomographic (CT) findings in HIV-infected patients referred for CT brain at Doctor George Mukhari Academic Hospital (DGMAH) and to correlate the CD4 counts with CT brain findings of the patients on antiretroviral (ARV) drugs, and those that are ARV naïve. Methods: A descriptive, retrospective review of CT brains obtained from 128 slices Philips and GE, CT scanners, medical records, and laboratory results of 364 adult HIV-infected patients over a 6-month period (October 1, 2016–March 31, 2017) was conducted at Radiology Department of DGMAH. Statistical analyses were made using a Statistical Program for Social Sciences software (SPSS version 19.0). Results: From the 364 CT brain findings of HIV-infected patients reviewed, 46.2% were male and 53.8% were female. The findings were as follows: brain atrophy (168; 46.2%); infarcts (55; 15.1%); hydrocephalus (24; 6.6%); white matter disease (18; 4.9%); mass lesions (13; 3.6%); rim enhancing lesions (12; 3.3%); intracranial bleed (11; 3.0%); tuberculous granuloma (32; 8.8%); tuberculous meningitis (15; 4.1%); and cryptococcal meningitis (2; 0.5%). Opportunistic infections and mass lesions still predominate at CD4 count <200 cells/mm3 although the reduction in the prevalence of opportunistic infections was observed. Brain infarct was seen at CD4 count <200 cells/mm3, and brain atrophy was seen at all CD4 count levels (median= 84 cells/mm3). Conclusion: This study was conducted in the post-highly active ARV therapy era, and the most common CT scan brain finding was brain atrophy, followed by brain infarct.
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Accuracy of transrectal strain elastography in detection of prostate cancer
Mangal Subhash Mahajan, Anish Choudhary, Dsouza John, Priscilla C Joshi
January-June 2019, 26(1):31-36
DOI:10.4103/wajr.wajr_13_18  
Background: Elastography has emerged as a boon in aiding diagnosis of various neoplastic conditions. Strain elastography helps in differentiating hard lesions from the normal tissue on a real-time basis and targeting biopsies of the same described by other authors in various conditions. We assess a series of cases for the detection of prostate cancer using strain elastography of prostate. Aims: The aim of this study was to assess the accuracy of transrectal strain elastography in diagnosis of prostate cancer. Materials and Methods: This is an observational cross-sectional, prospective study. Transrectal strain elastography was performed using a C-10 3 v endocavity probe with elastography software and was compared against biopsy results on 25 adult male patients with raised prostate-specific antigen levels. Statistical significance of qualitative data across two study groups was tested using the Chi-square test or Fisher's exact test. The entire data were analyzed using SPSS version 16.0, Inc., Chicago, software for Microsoft Windows. Results: Ten (40%) out of 25 patients demonstrated carcinoma prostate, 14 patients had benign prostatic hyperplasia, and 1 had prostatic abscess. Transrectal real-time elastography scores in patients with carcinoma patient were higher than those of benign conditions, i.e., 3 and 4 scores with accuracy of 92%, sensitivity of 85.7%, and specificity of 94.4%. Conclusions: The overall accuracy of strain elastography was 92%, which enhanced the diagnostic yield in prostate carcinoma. Real-time strain elastography is a highly sensitive and specific technique for diagnosing prostatic carcinoma and guiding the prostate biopsy.
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PICTORIAL ESSAY
Pattern of prenatal ultrasound diagnosed anterior abdominal wall defects at the University College Hospital, Ibadan, Nigeria: A pictorial essay
Janet Akinmoladun, Taiwo Lawal, Oluwasomidoyin Bello
January-June 2019, 26(1):43-49
DOI:10.4103/wajr.wajr_7_18  
Anterior abdominal wall defects form a wide spectrum of congenital abnormalities that allow the abdominal contents to protrude through an unusual opening on the abdominal wall. These defects could be physiological or pathological depending on the time of diagnosis. They include physiological gut herniation, congenital umbilical cord hernia, omphalocele, gastroschisis, ectopia cordis, bladder exstrophy, body-stalk anomaly, Prune-Belly Syndrome, and pentalogy of Cantrell. Correct prenatal diagnosis of these anomalies with ultrasound (US) is extremely important for patient management. Evaluation of the defect relative to the umbilical cord insertion site is fundamentally important in differentiating among the various malformations. We present a pictorial essay of the spectrum of anterior abdominal wall defects diagnosed prenatally with US seen over a 5-year period at the University College Hospital, Ibadan.
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ORIGINAL ARTICLES
Correlation of renal volume on ultrasound with renal function tests in hypertensives in University of Benin Teaching Hospital
Nkem Nnenna Nwafor, Ademola Adeyemi Adeyekun
January-June 2019, 26(1):37-42
DOI:10.4103/wajr.wajr_53_17  
Background: Long-standing essential hypertension can initiate changes in renal size and alteration in renal function which can be assessed using ultrasound and biochemical tests, respectively. Ultrasound is a noninvasive and affordable investigative modality that is readily available. Patients and Methods: One hundred and fifty patients consisting of 54 (36%) males and 96 (64%) females with essential hypertension attending cardiology outpatient clinic were recruited and investigated after obtaining an informed consent. Renal volume was calculated from ultrasound measurement of renal dimensions. Blood sample was assessed for serum creatinine and estimated glomerular filtration rate calculated using the Cockcroft and Gault (CG) and modification of diet in renal disease (MDRD) formulae. Data analysis was performed using Statistical package for Social Sciences version 17.0. Results: The mean renal volume was 115.7 ± 29.2 cm3 on the right and 132.4 ± 40.2 cm3 on the left. The mean renal volumes for males were 126.1 ± 27.9 cm3 and 141.1 ± 40.6 cm3 while values for female patients were 109.9 ± 28.2 cm3 and 127.5 ± 9.4 cm3 on the right and left, respectively. Differences in renal sizes on both sides were not statistically significant, P = 0.120 and 0.063. Values were significantly higher in male patients compared to the female patients, for both sides (P = 0.001 and 0.046 on the right and left, respectively). Mean serum creatinine was 0.9 ± 0.03 mg/dl. Conclusion: Male hypertensive patients had significant higher renal volume values than females. However, renal volume did not correlate with duration of hypertension for all the patients. There was no correlation between renal volume and renal function using CG and MDRD formula.
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CASE REPORTS
Rare magnetic resonance imaging findings in dengue encephalitis
Madhavi Karri, Balakrishnan Ramasamy
January-June 2019, 26(1):53-55
DOI:10.4103/wajr.wajr_17_18  
Dengue encephalitis is caused by a nonneurotropic virus of Flaviviridae group. It is a very rare manifestation of dengue fever caused by direct invasion of neural tissue into brain parenchyma. It causes a spectrum of neurologic manifestations such as meningitis, encephalitis, myelitis, and stroke. Here, we discuss a 20-year-old antenatal woman who presented with acute-onset fever and altered sensorium for 1 day. Blood investigations showed mild thrombocytopenia. Magnetic resonance imaging showed characteristic hemorrhagic encephalitis involving bilateral thalami and pons with diffusion restriction. Cerebrospinal fluid for the meningoencephalitic panel was negative. Serology for dengue NS1 antigen and immunoglobulin M antibody were positive. Although considered as a nonneurotropic virus, acute clinical presentation of fever, and altered sensorium apart from herpes and Japanese encephalitis, dengue encephalitis should also be regarded as one of the differentials.
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A case report of congenital bilateral proximal radioulnar synostosis in a 22-month-old child
Olayemi Atinuke Alagbe, Oluwatoyin Ige Oyekale, Tinuola Omolade Adeniyi
January-June 2019, 26(1):50-52
DOI:10.4103/wajr.wajr_57_17  
Congenital radioulnar synostosis is a skeletal abnormality present at birth which may appear clinically as a mild abnormality in the early years. The diagnosis is usually delayed until functional abnormality is noticed. This is a typical case of congenital bilateral proximal radioulnar synostosis diagnosed at about 2 years despite mild upper limb abnormality noticed at birth. The rarity of this condition prompted the report of this case.
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LETTER TO EDITOR
Suppurated inguinal node mimicking a strangulated inguinal ovarian hernia on ultrasound
Emmylou Prisca Gabrielle Andrianah, Lova Hasina Narindra Rajaonarison Ny Ony, Andry Nampoinanirina Rasolonjatovo, Hasina Ursèle Andrianarimanitra, Ahmad Ahmad
January-June 2019, 26(1):56-58
DOI:10.4103/wajr.wajr_46_17  
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