Nzeh Da

Sonographic pattern of gallbladder disease in children with sickle cell anaemia

A prospective analysis of ultrasound examinations of the gallbladder in 161 children with sickle cell anaemia revealed cholelithiasis in 7 cases (4.2%). Biliary sludge was present in 12 cases (7.5%). The commonest abnormality noted was gallbladder wall thickening seen in 13 patients (8.1%). The age range of patients studied was 2 1/2 months to 16 years with a mean of 7.96 years. The youngest age for development of cholelithiasis was 10 years while biliary sludge was noted earliest at 5 years. Gallbladder wall thickening appeared as early as 4 years. Dietary and environmental factors are probably responsible for the low incidence of cholelithiasis in Africans with sickle cell anaemia. The low incidence of cholelithiasis in the African child with this disease does not justify routine and follow-up ultrasound scans in all cases with sickle cell anaemia.

Prediction of birthweight by fetal ultrasound biometry

A total of 104 women with singleton pregnancies who were delivered between 37 and 42 weeks gestation had ultrasound scans during the fortnight before delivery. The biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were measured in all cases. Estimation of fetal weight (EFW) was done by four different methods: using AC alone, AC/BPD, AC/FL and AC/BPD/FL. Results were compared with values of actual birthweights at delivery. There was no significant difference between the mean birthweights of the 47 boy and 57 girl fetuses studied. The EFW(Shepard) method showed the least bias overall: mean percentage error 1.7%, standard deviation (SD) 10.6%. The other three methods significantly underestimated birthweights on average: EFW(Deter), mean error 2.2%, SD 9.3%, p < 0.02; EFW(Campbell), mean error 5.4%, SD 9.5%, p < 0.001; EFW(Hadlock), mean error 5.6%, SD 9.3%, p < 0.001. The percentage error in each group was significantly negatively correlated (p < 0.001) with the scan-delivery interval. Two new equations were generated which gave more accurate predictions for the cases under study using AC, BPD and FL as a combination and also in addition to scan-delivery interval (SDI) in days.

Ischemic stroke following abuse of Marijuana in a Nigerian adult male

Cannabis is the most widely used illicit drug among adolescents and young adults. Despite its widespread use, only a few reports exist on the association of cannabis use and stroke. A 26-year-old Nigerian male, developed right-sided ischemic stroke few hours after smoking three wraps of cannabis. He had smoked cannabis consistently for the past 4 years prior to the development of the stroke. Known stroke etiology and abuse of other illicit drugs were ruled out from history and investigations. Neuroimaging studies of the brain revealed infarcts in basal ganglia secondary to occlusion of blood flow in the left anterior and middle cerebral arteries. The mechanism of stroke in this patient was thought to be a cannabis-induced vasculopathy. Many cases of stroke in the young are increasingly being seen in hospitals in resource scarce countries. There seems to be a predilection for the basal ganglia in ischemic stroke following cannabis abuse. Therefore, cannabis abuse should be considered in young adults with basal ganglia infarcts, after excluding other known etiologies.

Sonographic assessment of the incompetent cervix in pregnancy

Ultrasonography (US) was done in 40 women with a history of recurrent midtrimester abortion. The results were compared with those of a control group who consisted of 53 women with no previous history of abortion and had had at least one full term pregnancy with normal vaginal delivery. Mean internal cervical os diameters of 16.0 mm and 22.5 mm at 10 and 27 weeks gestation respectively were recorded in the cervical incompetent patients while mean values of 7.7 mm and 14.5 mm at 13 and 28 weeks gestation were observed in the normal control subjects. Full analysis of covariance showed statistically significant difference in the internal os diameter between the control group and the cervical incompetence cases (t90 = 9.33, P < 0.001).

Importance of the jaw radiograph in diagnosis of Burkitt's lymphoma

An analysis of the plain film changes of the jaws in 51 histologically confirmed cases of Burkitts lymphoma was carried out. In tumours confined clinically to the jaws there was a 91% incidence of effacement of the dental lamina dura while in tumours confined clinically to the abdomen there was an incidence of 72.7%. When tumour deposits were clinically present in more than one anatomical site, almost all cases showed effacement of the dental lamina dura. These findings emphasise the need for jaw radiographs to reinforce the diagnosis in suspected cases of Burkitts lymphoma.

Transfontanelle ultrasonography: an invaluable tool in the assessment of the infant brain

Transfontanelle (cranial) ultrasonography, was carried out in 98 Nigerian infants over a period of 5 years. Of the infants, 38 (38.8%) had hydrocephalus from various causes while 26 (25.5%) had congenital anomalies. As ultrasound equipment is becoming a more readily available and affordable tool in the developing countries, it should become much easier for medical staff in these countries to arrive at the correct diagnosis of intracranial diseases in infants.

Atypical intrathoracic manifestations of Burkitt's lymphoma

Analysis of the plain chest radiographs of 11 children with Burkitts lymphoma showed that mediastinal adenopathy was the commonest abnormality present. One child showed a pulmonary infiltrative pattern which had previously been undescribed in this disease. Nigerian children with this lymphoma present more commonly with mediastinal glandular enlargement whereas pleural effusion is more frequently encountered in Caucasians.

Ultrasound evaluation of brain infections and its complications in Nigerian infants

Summary Infantile meningitis is a clinical diagnosis. However, suspicion of its complications may warrant further investigations; and transfrontanelle ultrasound is a reliable and cheap way to evaluate the usefulness of ultrasonography in diagnosing the complications of infantile meningitis. This is a retrospective study of the transfrontanelle ultrasound findings in 40 infants presenting with clinical indicators of complicated acute bacterial meningitis. There were 20 boys and 20 girls aged 5–115 days (mean, 42.6 ± 30.1 days). The complications of meningitis detectable on ultrasound were: hydrocephalus (21[52.5%]); cerebral abscess (2[5%]); subdural empyema (2 [5%]); and ventriculitis (3[7.5%]). Twelve babies (30%) had no abnormal findings. Hydrocephalus is the most common complication of meningitis in our setting. Transfontanelle ultrasound proved to be very reliable in the initial diagnosis and follow-up of complicated meningitis.

Comparison of ocular biometry measurements by applanation and immersion A-scan techniques.

Purpose The study compared ocular biometry values using applanation and immersion techniques to determine the most applicable method for our tertiary training centre where personnel with different levels of experience and expertise in biometry take measurements used in calculation of required intraocular lens before cataract surgery. Methods The study was a prospective cross-sectional comparative study of different techniques of ocular biometry from diagnostic equipment (biometry probe 10 MHz Sonomed® A-scan (PACSCAN 300A, USA). Measurement variables were obtained among children and adults undergoing cataract surgery. Scleral (Prager) shell was used for the immersion technique followed by the contact technique by the same examiner. Results The biometry values of 92 eyes of 92 adult were taken. Their ages ranged from 18 to 95 years with a mean of 64.7 (SD ± 12.9) years. There were 55 (59.8%) males and 37 (40.2%) females, with a male to female ratio of 1.5:1. Average axial length (22.0–24.4 mm) eyes were the most common eyes measured in 75 (81.5%) of the cases. The means of the axial lengths biometry values with immersion and contact technique were 23.66(±1.36) and 23.46 mm (±1.46); the axial length differences was 0.2 ± 0.26 mm (range 0.0–0.94 mm) and statistically significant (95% CI of the Difference 0.15 to 0.26, p = 0.000). The Standard deviation SD (mm) of Individual Eye Axial Length showed a mean of 0.03 ± 0.04 (0.0–0.3) mm for immersion and for contact technique 0.14 ± 0.12(0.0–0.6)mm. Conclusion There was a significant difference in ocular biometry measurement with the contact and immersion ultrasound techniques. The immersion technique had better repeatability, thus it is ideal in a training hospital setting in a typical in sub-Saharan Africa who have limited resources to employ a dedicated person to do biometry; and where the different operators of A-scan machines have different levels of experience and expertise.

Neuroimaging of young adults with stroke in Ilorin Nigeria

BACKGROUND Stroke in young adults is relatively uncommon. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most valuable tools for the diagnosis of stroke. Recent data on stroke in young adults in Nigeria is sparse. The aim of this study is to document the imaging pattern in young patients aged 15-45 years with suspected cerebrovascular accidents (CVA) in the Nigerian environment. MATERIALS AND METHODS This was a retrospective study of 69 patients aged 15-45 years, with clinical diagnosis of stroke, referred for neuro-imaging, from October 2008 to November 2013. All patients with the clinical diagnosis of stroke within this age group were recruited into the study. Images were obtained from a four slice channel general electric CT machine and a 0.2 Tesla Siemens Magnetom Concerto MRI scanner. RESULTS A total of 69 patients (44 males and 25 females) were studied. Sixty out of 69 (87.0%) patients were accurately diagnosed with CVA, with 9 (13.0) cases of misdiagnoses. A total of 21 (35%) out of the 60 cases confirmed on imaging had intracerebral hemorrhage (ICH), 10 (16.7%) had subarachnoid hemorrhage (SAH) and 29 (48.3%) had cerebral infarct (CI). Hypertension was the common risk factor for all stroke subtypes. The most common location for ICH, was the basal ganglia in 8 (38.8%), while the commonest pattern for CI, was lacunar infarct in the basal ganglia (51.7%). CONCLUSION The incidence of hemorrhagic CVA (ICH and SAH combined) was slightly higher than ischemic CVA in this study. Lacunar infarcts in the basal ganglia and also ICH in the basal ganglia were the most common patterns, both are strongly linked to hypertension. A diagnostic protocol of stroke in young adults, to include neuroimaging and other ancillary investigations is advocated for stroke in young adults as some of the etiologies are treatable.