Bukunmi Michael Idowu

Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders

Summary Background Stroke and hemiplegia are frequent complications of stroke. This study was performed to sonographically evaluate post-stroke hemiplegic shoulders and explore possible relationship(s) between the sonographic findings and clinical indices. Material/Methods Forty-five stroke patients and 45 age- and sex-matched controls were recruited. Standard sonographic examination of both shoulders was performed to assess for joint subluxation, rotator cuff tears, tendinosis, subacromial-subdeltoid bursitis or effusion and adhesive capsulitis. Results Hemiplegic shoulders exhibited significantly higher number of pathologies compared to the unaffected shoulders and shoulders of controls (p=0.000). One or more structural abnormalities were found in all 45 (100%) hemiplegic shoulders, 25 (55.6%) unaffected shoulders of the stroke subjects, and 39 (43.3%) control shoulders. The most frequent pathologies in the hemiplegic shoulders were the following: tendinosis of the long head of bicep tendon (48.9%), inferior shoulder subluxation (44.4%), co-existing subacromial-subdeltoid bursa/long head of bicep tendon sheath effusion (44.4%), and long head of bicep tendon sheath effusion only (40%). Tendinosis of the long head of bicep tendon was commoner in hemiplegic shoulders with poor motor status than those with good motor status. Conclusions Hemiplegic shoulders have significantly higher number of structural abnormalities than unaffected shoulders and the shoulders of controls. Hemiplegic stroke patients should undergo ultrasonography of the hemiplegic shoulder to define the nature and extent of soft tissue injuries prior to physical therapy.

Uterine Artery Doppler Velocimetry of Uterine Leiomyomas in Nigerian Women

Objective To describe the blood flow velocities and impedance indices changes in the uterine arteries of leiomyomatous uteri using Doppler sonography. Methods This was a prospective, case-control study conducted on 140 premenopausal women with sonographic diagnosis of uterine leiomyoma and 140 premenopausal controls without leiomyomas. Pelvic sonography was performed to diagnose and characterize the leiomyomas. The hemodynamics of the ascending branches of both main uterine arteries was assessed by Doppler interrogation. Statistical analysis was performed mainly using non-parametric tests. Results The median uterine volume of the subjects was 556 cm3, while that of the controls was 90.5 cm3 (p < 0.001). The mean peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMX), time-averaged mean velocity (Tmean), acceleration time (AT), acceleration index (AI), diastolic/systolic ratio (DSR), diastolic average ratio (DAR), and inverse pulsatility index (PI) were significantly higher in the subjects (94.2 cm/s, 29.7 cm/s, 49.1 cm/s, 25.5 cm/s, 118 ms, 0.8, 0.3, 0.6, and 0.8 respectively) compared with the controls (54.2 cm/s, 7.7 cm/s, 20.0 cm/s, 10.0 cm/s, 92.0 ms, 0.6, 0.1, 0.4, and 0.4 respectively); p < 0.001 for all values. Conversely, the mean PI, resistivity index (RI), systolic/diastolic ratio (SDR) and impedance index (ImI) of the subjects (1.52, 0.70, 3.81, and 3.81 respectively) were significantly lower than those of the controls (2.38, 0.86, 7.23, and 7.24 respectively); p < 0.001 for all values. Conclusion There is a significantly increased perfusion of leiomyomatous uteri that is most likely due to uterine enlargement.

Postgraduate radiology education in Nigeria: Looking backward and forward

Formal postgraduate radiology education (residency training) in Nigeria commenced in 1976 at the University College Hospital, Ibadan, Oyo State. Currently, two postgraduate medical colleges (one national and the other international or regional) are saddled with the responsibility of superintending the training programme. This is a chronicle of the evolution of radiology in Nigeria with emphasis on the current status of the training programme and areas that require improvement. Though the programme has delivered a quality healthcare workforce for the country and the international community since inception, significant but surmountable difficulties still exist. It is hoped that all stakeholders and policy-makers will take note and safeguard the future of the specialty.

Doppler sonography of perifibroid and intrafibroid arteries of uterine leiomyomas

Objective To sonographically evaluate the dominant fibroid nodule vascularity and flow velocity pattern of perifibroid and intrafibroid arteries. Methods We recruited 140 women with uterine fibroids. Their uteri were scanned to determine the vascularity of fibroid nodules and the Doppler indices of the fibroid arteries. Results The median volume of the dominant leiomyoma nodule was 133 cm3 (range=1.5–2,575 cm3). Eighty-three subjects (59.3%) had a dominant leiomyoma nodule volume of ≤200.0 cm3 while the volume of the dominant leiomyoma nodule was >200.0 cm3 in 57 (40.7%) subjects. The dominant fibroid nodule was vascular in 137 (97.9%) subjects and avascular in 3 (2.1%). All the perifibroid artery indices (except the end-diastolic velocity [EDV] and diastolic average ratio [DAR]) are significantly higher than those of the intrafibroid artery. The mean Doppler indices of perifibroid vs. intrafibroid arteries as follows: peak systolic velocity (PSV; 52.1 vs. 45.4 cm/s); EDV (21.1 vs. 22.4 cm/s); time-averaged maximum velocity (TAMX; 31.5 vs. 30.4 cm/s); time- averaged mean velocity (Tmean; 14.3 vs. 13.8 cm/s); pulsatility index (PI; 1.1 vs. 0.8); resistive index (RI; 0.6 vs. 0.5); systolic-diastolic ratio (SDR; 2.7 vs. 2.1); impedance index (ImI; 2.7 vs. 2.1); and DAR (0.66 vs. 0.74); P<0.001 for all indices. Conclusion The predominant pattern of fibroid vascularity is peripheral vascularity and the perifibroid artery indices (except EDV and DAR) are significantly higher than those of the intrafibroid artery. Recurrent fibroids in women with previous myomectomy had significantly higher intrafibroid PI, RI, SDR, and ImI than those without previous myomectomy.

Cost burden of neuroimaging during one-time admission for first-ever acute stroke in Nigeria

OBJECTIVE To determine the cost burden of Neuroimaging and its contribution to direct total hospitalization costs (HCs) during one-time admission for first-ever stroke. METHODS The clinical characteristics, direct itemised costs and total HCs for 170 consecutive patients with first-ever stroke, admitted at our public tertiary health facility over a 15-month period were evaluated. RESULTS The records of 170 stroke subjects were reviewed. The median total HCs for one-time admission per stroke patient was

Prostate carcinoma presenting with diffuse osteolytic metastases and supraclavicular lymphadenopathy mimicking multiple myeloma

183.30 with a median daily cost of

B-mode sonographic evaluation of optic nerve sheath diameter and lens thickness in Nigerian adults with glaucoma

15.86. Median cost of radiological investigations was the highest among the categorized hospital costs. Among the radiological investigations, neuroimaging accounted for at least 99% of cost to patients. CONCLUSION The financial burden of radiological investigations, particularly neuroimaging, is high during one-time admission of patients with first-ever stroke in our environment.

Sonographic quantification of pleural effusion: comparison of four formulae

Prostate cancer typically presents with osteoblastic metastases; however, patients with prostate cancer may have osteolytic metastases, as seen in this case. Patients with osteolytic metastases require a thorough evaluation to rule out malignancies including multiple myeloma, but prostate cancer is a very important differential diagnosis.

Uterine artery Doppler velocimetry in hypertensive disorder of pregnancy in Nigeria

Objective This study was done to investigate the effect(s) of glaucoma on the ocular optic nerve sheath diameter and lens thickness using B-mode ultrasonography. Materials and methods One hundred and twenty study participants were recruited; 60 subjects with glaucoma and 60 age- and sex-matched controls without glaucoma. The optic nerve sheath diameter and lens thickness of both eyes were measured using a linear high frequency transducer with frequency of 6.5–12MHz. Results The mean optic nerve sheath diameter of the glaucomatous eyes (3.57 ± 0.19mm and 3.59 ± 0.33mm on the right and left, respectively) were significantly thinner than that of controls (4.23 ± 0.34 mm and 4.26 ± 0.30 mm on the right and left, respectively; p < 0.001). There is increased mean lens thickness in the glaucomatous eyes (4.15 ± 0.43mm and 4.18 ± 0.46mm on the right and left, respectively) than in the controls (4.01 ± 0.56mm and 3.99 ± 0.45mm on the right and left, respectively) with a statistically significant difference seen in the left eye (p = 0.024). Conclusion B-mode ultrasound is a reliable tool of assessing the nerve sheath diameter and lens thickness in glaucoma. Optic nerve sheath diameter is reduced in glaucoma

Sonographic detection of inferior subluxation in post-stroke hemiplegic shoulders

Purpose The purpose of this study was to evaluate the correlations of ultrasonographically estimated volumes of pleural fluid with the actual effusion volume in order to determine the most reliable formula. Methods In 32 consecutive patients with clinically diagnosed pleural effusion, an ultrasound estimation was made of the volume of effusion using four different formulae, including two in the erect position and two in the supine position. Closed-tube thoracostomy drainage using a 28-Fr chest tube was performed. The total drainage was calculated after confirmation of full lung re-expansion and complete drainage by plain chest radiographs and ultrasound. The ultrasonographically estimated volume was compared to the actual total volume drained as the gold standard. Results There were 14 female and 18 male subjects. The mean age of all subjects was 41.56±18.34 years. Fifty percent of the effusions were in the left hemithorax. Metastatic disease accounted for the plurality of effusions (31.2%). The mean total volume drained for all the subjects was 2,770±1,841 mL. The ultrasonographically estimated volumes for the erect 1, erect 2, supine 1, and supine 2 formulae were 1,816±753 mL, 1,520±690 mL, 2,491±1,855 mL, and 1,393±787 mL, respectively. The Pearson correlation coefficients (r) for the estimate of each formula were 0.75, 0.81, 0.62, and 0.63, respectively. Conclusion Although both erect formulae showed similar correlations, the erect 2 formula (Goecke 2) was most closely correlated with the actual volume drained.