Rachael A Akinola

Mammography and mammographic screening: are female patients at a teaching hospital in Lagos, Nigeria, aware of these procedures?

PURPOSE To determine the level of awareness of mammography and mammographic screening amongst women in Lagos, Nigeria. MATERIALS AND METHODS A structured questionnaire was administered to 555 consecutively recruited women who visited various clinics at the Lagos State University Teaching Hospital, Ikeja, between January 2009 and June 2009. RESULTS The mean age of respondents was 38.16 ± 9 years, and the majority (59.6%) had a tertiary education. A family history of breast cancer was present in 33 (6.0%) women, less than 20% of whom had undergone mammography. Only 20% of all subjects were aware of the recommendation that they should receive routine mammography and mammographic screenings on an annual or biannual basis, depending on their age, and of the side effects associated with the procedure. The mass media was womens main source of information regarding these procedures. The majority (67.6%) of participants confirmed that they performed breast self-examinations, though less than 5% of them had had their breasts examined by mammography. CONCLUSION This study revealed a rather low level of awareness about mammography and mammographic screening, indicating the need to educate women about the risk of breast cancer and the importance of screening as a tool for the early detection and treatment of this condition.

Prevalence of pulmonary hypertension in sickle cell anaemia patients of a tertiary hospital in Nigeria

Background: Sickle cell disease (SCD) is an inherited haemoglobinopathy characterised by recurrent organ hypoxia-reperfusion cycles which may result in repeated organ damage including the lungs and heart. In SCD, pulmonary hypertension is a known complication that may precede or complicate acute chest syndrome which is often fatal. This study seeks to know the prevalence of pulmonary hypertension and its relationship with clinical and laboratory parameters in sickle cell disease patients attending a tertiary hospital in Lagos. Materials and Methods: This was a case — control study involving patients with sickle cell disease recruited from adult sickle cell clinic of Lagos State University Teaching Hospital, Ikeja and HbAA controls matched for age and sex from a tertiary educational institution in Lagos. Both the patients and controls were subjected to echocardiography and pulmonary hypertension was deduced from their cardiac tricuspid regurgitant jet velocity. Other parameters measured were age, body mass index, full blood count, red cell indices, foetal haemoglobin, chest X-ray, liver function tests, lactate dehydrogenase and pulmonary function tests. Consenting patients were 56 HbSS in steady state and 28 HbAA controls matched for age and sex. Data was analysed using SPSS version 16.0. Results: The mean age of patients was 22 ± 6 years. In two 2 of 56 (3.6%) of the participants with sickle cell disease, the pulmonary artery pressure was > 25mmHg and there was significant difference in the mean of the pulmonary artery pressure of the control and that of the patients (P-value 0.013). Also, using the appropriate correlation tests, there was significant relationship between the pulmonary artery pressure and lactate dehydrogenase, aspartate transferase and haematocrit in patients with sickle cell disease. Conclusion: Sickle cell disease is an independent cause of pulmonary artery hypertension. Variation in cardiovascular reactions to recurrent hyperhaemolysis and hyperdynamic state in sickle cell disease may explain differences in the development of cardiac complications. Exploration of these reactions may reveal other therapeutic measures to prevent complications in sickle cell disease. Clinical assessment of adult patients with sickle cell disease should include echocardiography.

Mammograms and breast arterial calcifications: looking beyond breast cancer: a preliminary report

BackgroundTo find out the prevalence, clinical and biochemical correlates of Breast Artery Calcification (BAC) in the Nigerian women.FindingsThis is a cross sectional study involving 54 consecutive adult female subjects sent to the Radiology Department of the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria for screening and diagnostic mammography. The study was carried out for a period of five months.The prevalence of BAC was 20%. Ageing was found to be related to BAC. Cardiovascular risk factors including diabetes mellitus (DM), hypertension, obesity, alcohol ingestion, use of oral contraceptives and hormone replacement therapy, were not significantly related to the presence of BAC in this study.ConclusionThis study showed that though the presence of BAC in a mammogram is related to age, it may not predict or serve as a significant marker for cardiovascular diseases (CVD) in women in our environment.

Mohan's valvotome for the ablation of posterior urethral valves

INTRODUCTION Treatment of posterior urethral valves (PUV) is now most commonly by endoscopic valve ablation, but this is not readily available in our environment. We describe our experience with Mohans valvotome for the ablation of PUV. MATERIALS AND METHODS All patients with PUV who underwent Mohans valvotomy over a 28-month period from June 2006 were reviewed. RESULTS There were 35 patients. The median age was 1.5 years (mean age 3.0 years, range 11 days to 14 years). Eleven (31.4%) and 24 (68.6%) patients received the treatment under local and general anaesthesia, respectively. Adequate relief of obstruction was achieved in all patients with marked improvement in the urinary stream. Complications were recorded in two (5.7%) patients; one was re-operated because of recurrent urinary retention, and the other had urinary incontinence which resolved after 3 months. At follow-up of 1-28 months (median 14 months), three (8.6%) patients had died from sepsis and malnutrition. The 32 (91.4%) surviving have good urinary stream, normal renal function (serum creatinine level <1.5mg/dl) and resolution of hydronephrosis as demonstrated on ultrasound. There was no mortality resulting directly from the use of Mohans valvotomy. CONCLUSION Mohans valvotome is an effective instrument for the ablation of PUV. It is invaluable in the developing world where paediatric endoscopes are not readily available.

Caval variations in neurologically diseased patients

Background The import of the cavum variation and its prevalence rate in healthy individuals is still not clear, likewise in neurologically diseased patients. Purpose To evaluate the frequency and pattern of caval variations in neurologically diseased patients. Material and Methods The presence or absence of the cavum septum pellucidum (CSP), cavum vergae (CV), or cavum velum interpositum (CVI) was reviewed from successive cranial computerized tomography (CT) images of patients who were aged 6 months and above. Two hundred and seventeen cranial CT images were reviewed. Results At least a cavum variation was noted in 130 (59.9%) of the CT scan images reviewed. The CV, CVI, and CSP were noted in 86 (39.6%), 53 (24.4%), and 50 images (23%), respectively. Caval multiplicity was noted in 102 patients (47%). There was no significant difference in the rate of occurrence of cavum variations in patients with congenital brain diseases and acquired brain conditions (P = 0.484), neither was there a significant difference in the frequency of cavum variation in children aged older than 6 months compared to adults (P = 0.101). Conclusion Cava variations are relatively common in neurological brain diseases. Patients with congenital brain diseases did not have a higher frequency of cava variation when compared with those that had acquired lesions. The most common type of cavum variation noted in this study was the vergae variety, while the CSP is the rarest.

Prenatal ultrasonic diagnosis of conjoint twins

BACKGROUND A primipara with multiple pregnancy who booked for antenatal care at 21 weeks presented with vaginal bleeding and pedal oedema at the 27th week. She had had five previous ultrasound scans that gave conflicting results. MATERIALS AND METHODS The patient was therefore sent for a confirmatory scan, which was performed using a linear 3.5 MHz transducer of a dynamic imaging dedicated, concept MC ultrasound scan machine. RESULTS A diagnosis of conjoint twins was made. The twin was joined from the mandible to the abdomen. Although they cried at birth, they died a few minutes after. The pregnancy was terminated by caesarian section at the patients request. The patient did well postpartum and was discharged on the 5th postoperative day. Records confirm that this is the first case seen in this hospital, which has been in existence for 18 years. CONCLUSION To diagnose conjoint twins by ultrasound, one needs the expertise and careful scanning techniques, as the diagnosis may be easily missed, especially if the union is extensive.

Swollen Forearm in an 11 year Old Nigerian Boy

The diagnostic challenges in an 11 year old boy with a swollen forearm in a resource limited country, Nigeria, is discussed, with a brief review of literature of the causes of forearm swelling in a child and vascular malformations. This case is presented because of the rarity of arteriovenous malformation and the difficulty in making a diagnosis due to its low level of suspicion as a differential diagnosis. In this country where there is paucity of vascular surgeons, the challenges of management of arteriovenous malformations and the various imaging modalities are discussed. KEY WORDS: Swollen forearm, Vascular malformation, Venography, Doppler scan, CT Angiography

Contraception Failure Due to Uterine Didelphys: A Case Report

We present the case of an unsuspected uterine didelphys in a 28-year old woman who has had three previous caesarian sections after which an intrauterine contraceptive device was inserted. She, however, got pregnant again, was evacuated and the IUCD was removed. Persistence of the pregnancy symptoms informed a pelvic scan which confirmed a viable early intrauterine pregnancy with a suggested coexisting fibroid in the pouch of Douglas. A caesarian section was performed at term and a live female infant was delivered. Detailed scrutiny during caesarian section confirmed another uterus with its appendages on the right within the pouch of Douglas, separate from the gravid uterus on the left. This makes uterine didelphys as the probable cause of the contraceptive failure. Key words: uterine didelphys pregnancy, caesarian section, ultrasound, contraceptive failure

Audit of Congenital Fetal Anomalies as Seen on Ultrasound Scan in a Teaching Hospital in Ikeja, Lagos, Nigeria

Birth defects are becoming a major health problem in this part of the world. Early diagnosis helps to reduce the burden of perinatal mortality by availing practitioners and patients the option of abortion or prenatal intervention. This study seeks to evaluate the contribution of routine antenatal ultrasonography performed in this centre, to prenatal diagnosis of fetal structural defects. All pregnant women who were referred to the radiology department for obstetric scan from January 2000 to December 2007 were included in this study. The mean age of the patients was 26.2 +/- 5 years, while the mean gestational age at examination was 28 weeks +/- 2 weeks. There were 8753 patients, and 64 congenital anomalies were correctly diagnosed. Polyhydramnious was associated with the majority (48.44%) of congenital anomalies diagnosed, while 12.5% had oligohydramnious. Twenty five (39.06%) of them had normal amniotic fluid volume. Neural tube defects were the commonest type of anomalies, followed by gastrointestinal and renal defects. Most facial, chromosomal and cardiac defects were missed. To improve the diagnosing ability for fetal congenital anomalies, sonologists must be properly trained and the number of patients seen per clinic must be restricted to that which the sonologist would conveniently cope with. Early antenatal scan will improve the detection rate. Keywords : Congenital anomalies, Ultrasound scan, Teaching hospital, Nigeria Nigerian Journal of Health and Biomedical Sciences Vol. 7 (2) 2008: pp. 61-65

Fetus-in-fetu

INTRODUCTION Fetus-in-fetu (FIF) is a pathological condition in which the malformed foetus is found in the body of its twin. We report this rare case of a 3-month-old female baby whose diagnostic work-up suggested a mesenteric cyst but the mass at surgery was a FIF. DISCUSSION Although current imaging modalities like computerized Tomography and magnetic resonance imaging have a higher Sensitivity for accurate delineation of tissues, cheaper imaging alternatives like plain abdomen and ultrasonography still have a place in the preoperative work-up of FIF.