Godwin I Ogbole

Abdominal ultrasonography in HIV/AIDS patients in southwestern Nigeria

BackgroundThough the major target of the HIV-virus is the immune system, the frequency of abdominal disorders in HIV/AIDS patients has been reported to be second only to pulmonary disease. These abdominal manifestations may be on the increase as the use of antiretroviral therapy has increased life expectancy and improved quality of life. Ultrasonography is an easy to perform, non invasive, inexpensive and safe imaging technique that is invaluable in Africa where AIDS is most prevalent and where sophisticated diagnostic tools are not readily available. Purpose: To describe the findings and evaluate the clinical utility of abdominal ultrasonography in HIV/AIDS patients in Ibadan, NigeriaMethodsA Prospective evaluation of the abdominal ultrasonography of 391 HIV-positive patients as well as 391 age and sex-matched HIV-negative patients were carried out at the University College Hospital, Ibadan.ResultsOf the 391 cases studied, 260 (66.5%) were females; the mean age was 38.02 years, (range 15–66 years). The disease was most prevalent in the 4th decade with an incidence of 40.4%. Compared with the HIV-negative individuals, the HIV+ group of patients had a significantly higher proportion of splenomegaly (13.5% vs. 7.7%; p < 0.01), lymphadenopathy (2.0% vs. 1.3%; p < 0.70), and renal abnormalities (8.4% vs. 3.8%; p < 0.02). There were no differences in hepatic and pancreatic abnormalities between the HIV+ and HIV- groups. There were significantly fewer gallstones in the HIV+ group (1.4% vs. 5.1%; p < 0.01).ConclusionAIDS is a multi-systemic disease and its demographic and clinical pattern remains the same globally. Ultrasonography is optimally suited for its clinical management especially in Africa. Its accuracy and sensitivity may be much improved with clinico-pathologic correlation which may not be readily available in developing countries; further studies may provide this much needed diagnostic algorithms.

Quadrigeminal plate cistern lipoma

Intracranial lipomas are rare benign neoplasms accounting for <0.1% of all primary brain tumours. Most lipomas were incidentally detected by autopsy or computed tomography (CT).These slow growing benign lesions are usually asymptomatic and rarely require surgery. We report the case of a 70-year-old Nigerian woman who presented with persistent headaches following involvement in a road traffic accident 20 days previously. CT demonstrated a quadrigeminal cistern lipoma with no evidence of raised intracranial pressure or compression of neural structures. Her headaches resolved with conservative care. We describe the CT findings with a brief review of the literature.

Testicular tuberculosis presenting with metastatic intracranial tuberculomas only: a case report

IntroductionIntracranial tuberculomas are a rare complication of tuberculosis occurring through hematogenous spread from an extracranial source, most often of pulmonary origin. Testicular tuberculosis with only intracranial spread is an even rarer finding and to the best of our knowledge, has not been reported in the literature. Clinical suspicion or recognition and prompt diagnosis are important because early treatment can prevent patient deterioration and lead to clinical improvement.Case presentationWe present the case of a 51-year-old African man with testicular tuberculosis and multiple intracranial tuberculomas who was initially managed for testicular cancer with intracranial metastasis. He had undergone left radical orchidectomy, but subsequently developed hemiparesis and lost consciousness. Following histopathological confirmation of the postoperative sample as chronic granulomatous infection due to tuberculosis, he sustained significant clinical improvement with antituberculous therapy, recovered fully and was discharged at two weeks post-treatment.ConclusionThe clinical presentation of intracranial tuberculomas from an extracranial source is protean, and delayed diagnosis could have devastating consequences. The need to have a high index of suspicion is important, since neuroimaging features may not be pathognomonic.

Internal jugular phlebectasia in an African adult.

Jugular vein phlebectasia is a rare venous anomaly commonly presenting as a unilateral neck swelling in children and adults. Its aetiology is unknown and its detection may have increased with availability of better imaging facilities. Due to its rarity, a high index of suspicion is required once other causes of neck swelling are excluded. The few reported cases are mainly in children and non-Africans adults. The authors report the case of a 54-year-old Nigerian woman presenting for the first time with a progressive, intermittent, painless right neck swelling, which was demonstrated on Doppler ultrasound and CT angiography to be an internal jugular phlebectasia. She had satisfactory surgical excision of the dilated segment for cosmetic reasons.

Cranial computed tomographic findings in Nigerian women with metastatic breast cancer

Introduction: Brain metastases (BM) occur in up to one-fifth of patients with metastatic breast cancer (MBC). Imaging plays a key role in diagnosis. The pattern and distribution of these changes are also crucial to their management. These patterns have not been fully studied in Nigerian women. Materials and Methods: Retrospective analysis of the findings on the cranial Computed Tomography (CT) scans performed in 59 breast cancer patients with suspected BM treated at the University Teaching Hospital in Ibadan, between 2005 and 2010. The imaging features were evaluated in relation to their clinical characteristics. Results: In the 59 patients studied (mean age 50.9 years ± 11.75 SD), headache (40.7%) and hemiparesis/hemiplegia (16.9%) were the commonest clinical presentation. Lytic skull lesions were seen in 15 patients (25.4%), most commonly in the parietal bones. Thirty-nine patients (66.1%), had parenchymal brain lesions, and only 8 (20.5%) of these were single lesions. Most of the lesions were isodense (19/39; 51.4%) the parietal lobe was the most common site with 50.8% (30/59) occurrence and the leptomeninges the least with 13.6% (8/59). Orbital or sellar region involvement occurred in only two patients. The size of the lesions, was <2 cm in 17 (28.8%), 2-5 cm in 14 (23.7%) and >5 cm in 5 patients. Sixteen (27.1%) patients were free of any lesion either in the skull or brain. Patient presenting with multiple brain lesions were more likely to have skull lesions though this was not statistically significant (P = 0.584). Conclusion: The brain continues to be a sanctuary site for breast cancer metastases and CT imaging remains an invaluable tool in the clinical evaluation and therapeutic management of Nigerian women with BM from MBC. It also appears that the demographic and imaging findings in these patients are similar to other racial groups.

Routine prenatal ultrasound anomaly screening program in a Nigerian university hospital: Redefining obstetrics practice in a developing African country.

Background: Congenital anomalies are among the leading causes of fetal and infant morbidity and mortality worldwide. Prenatal ultrasound (US) screening has become an essential part of antenatal care in the developed world. Such practice is just evolving in the developing countries such as Nigeria. The aim of this article is to present our initial experience and demonstrate the effectiveness of a prenatal US screening program in detecting congenital malformation in a developing country. Materials and Methods: This was a prospective evaluation of the prenatal US screenings conducted at a major referral hospital in Southwestern Nigeria. All pregnant women referred to the antenatal clinic for mid-trimester screening during the period of study were assessed. Results: Two hundred and eighty-seven pregnant women (5 with twin gestations) were presented for fetal anomaly scan during the study period. Twenty-nine anomalies (9.9%) were detected among the scanned population. Sixteen of the anomalies were followed to delivery/termination with a specificity of 93.5%. The commonest malformations were demonstrated in the genitourinary tract (34.5%) followed by malformations within the central nervous system (27.6%). Six (20.6%) of the anomalies were lethal. Five of the anomalies were surgically correctable. Conclusion: Institutions and hospitals across Nigeria and other low- and middle-income countries need to develop policies and programs that would incorporate a standardized routine screening prenatal US in order to improve feto-maternal well-being and reduce the high perinatal mortality and morbidity in developing nations.

Incidental cranial CT findings in head injury patients in a Nigerian tertiary hospital.

Background: Incidental findings on computed tomography (CT) scans are occasionally noted in patients presenting with head injury. Since it can be assumed that head injured patients are of normal health status before the accident, these findings may be a representation of their frequency in the general population. Our aim was to determine the prevalence of such incidental findings among head injured patients in Nigerias foremost center of clinical neurosciences. Materials and Methods: We conducted a retrospective review of CT scan images of 591 consecutive eligible patients over a 5-year period (2006-2010) to identify incidental findings. The images were evaluated by consensus agreement of two radiologists. Associations with gender and age were explored using appropriate statistical tests with an alpha level of 0.05. Results: The mean patient age was 34.6 ± 21.2 years, and male to female ratio was 3.2: 1. Incidental findings were noted in 503/591 (85.1 %) of the scans. Intracranial calcification was the commonest finding occurring in 61.8% of patients. Over 90% of the findings were benign. Compared with older ones, patients under the age of 60 were less likely, (P < 0.001), to have incidental findings. Conclusion: Although the majority of incidental findings in this African cohort of head injury patients are benign some clinically significant lesions were detectable. It is therefore recommended that such findings be adequately described in the radiological reports for proper counseling and follow-up.

Pattern of lumbosacral magnetic resonance imaging findings in diagnosed cases of disc degenerative disease among Nigerian adults with low back pain

Background: Lumbar spine disc degenerative disease (DDD) has been proven to be the most common cause of low back pain which causes musculoskeletal disability. Magnetic resonance imaging (MRI) allows detailed evaluation of all components of the lumbar spine and assesses abnormalities that may be associated with disc degeneration. Objective: To document the frequency of lumbosacral MRI findings in DDD with correlation to age, gender, and lumbar disc level. Methodology: Two hundred and eighty-one out of three hundred archived magnetic resonance images of patients aged 18 years and above investigated for low back pain at Memfys Hospital for Neurosurgery were enrolled into the study. Axial and sagittal magnetic resonance images were acquired at 5 mm slice thickness with 1 mm gap using spin echo pulse sequence. Results: The mean age of the study population was 55.11 years with a range of 18-91 years. Highest frequency of disc degenerative changes fell within 50-59 years age group and L4/L5 level with male preponderance. Positive findings were disc bulge 51.2%, disc protrusion 87.5%, disc extrusion 19.6%, disc sequestration 1.78%, Modic endplate changes 47.4%, Modic I 10.7%, Modic II 15.3%, and Modic III 21.4%. Logistic regression analysis showed that only posterior disc protrusion and disc bulge were significant. Odd ratio 0.062 and 0.015, respectively, while the beta values are −4.190 and −2.780, respectively. Conclusion: The most common lumbosacral MRI findings in diagnosed cases of DDD among patients with low back pain in this study were posterior disc protrusion, posterior disc bulge, and endplate changes.

Radiation doses to the uterus and ovaries in abdominopelvic computed tomography in a Nigerian Tertiary Hospital

Background: Computed tomography (CT) has remained an important tool in medical diagnosis. However the radiation dose imparted to patients, especially to radiosensitive organs during a CT scan, continues to raise concern. Our aim was to determine the radiation dose to the ovary and the uterus during routine abdomen/pelvis CT examinations at the University College Hospital, Ibadan, Nigeria using appropriate dose computational methods. Materials and Methods: Technical factors and parameters were obtained for three groups of 60 randomly selected patients who had abdominal CT examinations using three machines, namely; the CT/e, BrightSpeed S and Toshiba Aquilion 64. The scanning parameters were used to estimate the patient organ doses using measurements of CT dose indexes and organ doses obtained with the aid of the ImPACT CT Dosimetry Calculator SpreadSheet based on National Radiological Protection Board conversion factors. Results: The mean total organ dose from the CT/e machine to the ovary was 11.15 ±2.48 (mGy) and to the uterus was 12.10 ±2.57 (mGy), and the mean total organ dose from the BrightSpeed S machine to the ovary was 39.2 ± 22.66 (mGy) and to the uterus was 43.05 ±24.88 (mGy), while the mean total organ dose from the Toshiba Aquilion 64 to the ovary was 33.07 ±16.86 (mGy) and to the uterus was 33.85 ±18.58 (mGy). These values were mostly comparable to but slightly higher than values of similar organ doses reported in the literature for Tanzania, the United Kingdom, Germany, and Japan. The doses to the ovary and uterus obtained varied from other international surveys by 3.8–12.9 mGy and 3.17–15.07 mGy, respectively, representing a 25–50% dose increase. Conclusion: The organ doses to the ovary and the uterus at our facility are higher than those obtainable in other countries; however, this could be substantially minimized through optimization of CT scanning protocols.

Subclavian artery aneurysm with incidental bovine aortic arch branch

Aneurysms of the Subclavian artery are uncommon, accounting for less than 0.2% of all arterial aneurysms. The most common causes are arteriosclerosis, thoracic outlet obstruction, and trauma. Anomalous branching aortic arrangements are less uncommon, occurring in some 35% of subjects. We report a case of subclavian artery aneurysm in a 62-year- old man presenting with a painless right supraclavicular swelling of approximately 30 years duration. He was a known hypertensive diagnosed 21 years previously and compliant with medication. His serum lipid profile was normal. Doppler Ultrasound of the right subclavian artery showed a thin walled fusiform aneurysmal dilatation located 3.6 cm from its origin with fine internal echoes, and measuring 2.74 cm in diameter. Peak systolic velocity (PSV) within the aneurysm was 33 cm/s, compared with 55 cm/s and 45 cm/s in the right pre-aneurysmal segment and left subclavian arteries respectively. There was turbulent flow and spectral broadening within the aneurysm. Computerized Tomographic (CT) angiography of the aortic arch confirmed a right subclavian aneurysm, and showed an anomalous origin of the left common carotid and subclavian arteries. An anomalous common origin of the left common carotid from the brachiocephalic trunk representing a bovine type variant is a rare condition, its association with subclavian artery aneurysm an even rarer finding.