Correlative Ultrasound Evaluation of Anterior Abdominal Wall Subcutaneous Tissue Thickness in Type 2 Diabetic and Non-Diabetic Adults.

BACKGROUND: Subcutaneous fat accumulation complicating diabetes mellitus (DM) has long been recognised, even as its clinical significance remains controversial. Ultrasound is safe and accurate in assessing soft tissue dimensions. Reports on ultrasound evaluation of anterior abdominal wall subcutaneous fat in diabetic and apparently healthy normoglycaemic subjects are scanty in the Nigerian environment. AIMS AND OBJECTIVES: To sonographically assess and compare the mean anterior abdominal wall subcutaneous tissue thickness (AAST) in adult diabetic subjects and apparently healthy, normoglycaemic subjects and correlate the values with age, gender, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and glycated hemoglobin (Hb1c). MATERIALS AND METHODS: The AAST in 150 adult diabetic subjects and equal numbers of age, and sex matched apparently healthy individuals was assessed with a SONOACE X4 ultrasound scanner. (Medison Inc, SOUTH KOREA), using a l inear array transducer of frequency 7. 5MHz10MHz.Measurements were taken in the midline at two points; 2cm above and below the umbilicus. Anthropometric parameters such as BMI, WC, WHR, were recorded. RESULTS: Adult diabetic subjects had significantly higher AAST values, compared to age and BMI matched male and female apparently healthy controls respectively. (2.7±0.9cm vs 2.2 ± 0.9cm (below the umbilicus; p=0.001), and 2.1 ± 0.8cm vs 1.6 ± 0.8cm (above the umbilicus; p = 0.001). Below the umbilicus, AAST correlated positively with WHR, BM1 and disease duration among diabetic patients. CONCLUSION: AAST is significantly increased in diabetic subjects compared to controls, and can be a useful guide in the management of obesity in these patients. There is correlation of AAST below the umbilicus with BMI and waist circumference.

CONTEXTE: Accumulation de graisse sous-cutanée compliquant le sucré (DM) est reconnu depuis longtemps, même s'il est linique l'importance est restée controversée. L'échographie est sûre et précise dans l'évaluation des dimensions des tissus mous. Rapports sur l'évaluation échographique de graisse sous-cutanée de la paroi abdominale antérieure chez le diabétique et apparemment les sujets normogl ycémiques en bonne sant é sont rares au Ni géri a environnement. BUTS ET OBJECTIFS: Évaluer et comparer par échographie l'épaisseur moyenne du tissu sous-cutané de la paroi abdominale antérieure(AAST) chez les sujets diabétiques adultes et apparemment en bonne santé, normoglycémique sujets et corréler les valeurs avec l'âge, le sexe,indice de masse corporelle (IMC), tour de taille (WC), taille à hanchesrapport (WHR) et hémoglobine glyquée (Hb1c). MATÉRIAUX ET MÉTHODES: L'AAST chez 150 diabétiques adultes sujets et nombre égal d'âge et de sexe apparié apparemment en bonne santé ont été évalués à l'aide d'un échographe SONOACEX4.(Medison Inc, CORÉE DU SUD), en utilisant un transducteur linéaire defréquence 7.5 MHz-10 MHz.Des mesures ont été prises dans la ligne médianeen deux points; 2cm au-dessus et au-dessous de l'ombilic. Anthropométrique des paramètres tels que l'IMC, WC, WHR, ont été enregistrés. RÉSULTATS: Les sujets diabétiques adultes avaient un AAST plus élevé valeurs, par rapport à l'âge et à l'IMC appari és hommes et femmes apparemment cont rôl es sai ns respectivement. (2.7±0.9 cm vs 2.2 ± 0.9 cm (sous leombilic; p=0.001), et 2.1 ± 0.8cm contre 1.6 ± 0.8cm (au-dessus de laombilic; p = 0.001). Sous l'ombilic, AAST corrélépositivement avec WHR, BM1 et durée de la maladie chez les diabétiques patient. CONCLUSION: AAST est significativement augmenté chez lessujets diabétiques par rapport aux contrôles, et peut être un guide utile dans la gestion d' obésité chez ces patients. Il y a une corrélation de l'AAST sous l'ombilic avec IMC et tour de taille. Mots-clés: Paroi abdominale antérieure, diabète, obésité, tissus mous,ultrason.

Sonographic evaluation of renal parameters in individuals with essential hypertension and correlation with normotensives.

BACKGROUND: Hypertension can secondarily involve the kidneys, and renal sonographic parameters can be used to indirectly assess renal function or status. Ultrasound is an inexpensive and safe modality for evaluating the kidneys. The purpose of this study was to sonographically assess renal parameters in patients with essential hypertension to determine the parameters that may indicate increased risk of renal damage. MATERIALS AND METHODS: One hundred and fifty individuals (96 females and 54 males) with essential hypertension attending consultant outpatient clinic in University of Benin Teaching Hospital were evaluated. An equal number of nonhypertensive volunteers comprising of 80 females and 70 males were studied as controls. For individuals and controls, the renal length, width, anteroposterior diameters, renal parenchymal volume, cortical thickness, and echogenicity were assessed. Serum creatinine was also obtained. Statistical Package for the Social Sciences (SPSS version 17.0) was used in data analysis. RESULTS: The mean renal parenchymal volume and cortical thickness were 99.1 ± 25.8 cm3 and 1.0 ± 0.2 cm on the right and 113.8 ± 35.8 cm3 and 1.0 ± 0.2 cm on the left for the hypertensive individuals. The values for the normotensives were 100.5 ± 19.8 cm3 and 1.2 ± 0.2 cm on the right and 118.7 ± 27.4 cm3 and 1.3 ± 0.2 cm on the left. The difference in cortical thickness between the two groups was statistically significant. No significant difference was noted between renal parenchymal volume of the right and left kidneys in the individuals and controls. The variation in cortical echogenicity between the hypertensives and controls was statistically significant; 74.0% and 75.3% of hypertensives and 28.0% and 26.0% of normotensives had increased cortical echogenicity on the right and left kidneys, respectively. The serum creatinine value was significantly higher in the hypertensive group. CONCLUSION: Cortical echogenicity grading was significantly higher among hypertensives than normotensives while renal parenchymal volume and cortical thickness were lower among hypertensives. In the hypertensives and normotensives, renal parenchymal volume, cortical thickness, and renal length were higher in males compared to the females and in the left kidney compared to the right. Hypertension seems to have more effect in the renal cortex than the medulla.

Ultrasound estimation of foetal gestational age by transcerebellar diameter in healthy pregnant nigerian women.

BACKGROUND: Ultrasonography has application in advanced obstetric practice through relatively detailed assessment of foetal anatomy and accurate assessment of gestational age (GA), especially during the first half of pregnancy. Foetal trans-cerebellar diameter (TCD) is an emerging parameter for gestational age determination among Africans. AIM: This study was carried out to establish baseline data for TCD at various corresponding gestational ages in Nigerian women, and evaluate the correlation between these two parameters. MATERIALS AND METHODS: Four hundred and fifty healthy singleton pregnant women, referred for antenatal scans were prospectively studied, following informed consent. Main inclusion criterion was certain last menstrual dates. A SONOACE χ6 ultrasound scanner, with a curvilinear probe and 3.5 MHz transducer, was used to measure the TCD. Data analysis was done and statistical significance set at p ≤ 0.05. RESULTS: TCD of the foetuses studied ranged from 11.9 mm (at 13 weeks) to 59.3mm (at 41 weeks) with a mean value 34.2 ± 14.1mm.There was significant correlation between TCD and menstrual gestational age (r =0.984; p=0.000). TCD has a predictive accuracy of 96.9% with a standard error of ± 10 days. CONCLUSION: A normogram of foetal TCD throughout gestation is established for Nigerian Africans.

PREDICTIVE ACCURACY OF TRANSCEREBELLAR DIAMETER IN COMPARISON WITH OTHER FOETAL BIOMETRIC PARAMETERS FOR GESTATIONAL AGE ESTIMATION AMONG PREGNANT NIGERIAN WOMEN.

OBJECTIVE: To compare the predictive accuracy of foetal trans-cerebellar diameter (TCD) with those of other biometric parameters in the estimation of gestational age (GA). DESIGN: A cross-sectional study. SETTING: The University of Benin Teaching Hospital, Nigeria. SUBJECTS: Four hundred and fifty healthy singleton pregnant women, between 14-42 weeks gestation. MAIN OUTCOME MEASURES: Trans-cerebellar diameter (TCD), biparietal diameter (BPD), femur length (FL), abdominal circumference (AC) values across the gestational age range studied. Correlation and predictive values of TCD compared to those of other biometric parameters. RESULTS: The range of values for TCD was 11.9 - 59.7mm (mean = 34.2 ± 14.1mm). TCD correlated more significantly with menstrual age compared with other biometric parameters (r = 0.984, p = 0.000). TCD had a higher predictive accuracy of 96.9% ± 12 days), BPD (93.8% ± 14.1 days). AC (92.7% ± 15.3 days). CONCLUSION: TCD has a stronger predictive accuracy for gestational age compared to other routinely used foetal biometric parameters among Nigerian Africans.

Computerised tomographic patterns in patients with head injury at the university of Benin teaching hospital.

BACKGROUND: Head injuries rank high among morbidities due to trauma. Computerised tomography is an important modality in the investigation of these cases. However, literature on this subject in the south-south geopolitical zone of Nigeria is sparse. This study therefore aimed to document the computerized tomographic features of patients with head injury managed at the University of Benin Teaching Hospital (UBTH). MATERIALS AND METHODS: A prospective study involving patients with head injury referred for CT scan from the Accident and Emergency Unit of UBTH over a 12-month period. A total of 100 patients were studied, using non-enhanced cranial CT scans. Findings were recorded and data analysis using SPSS done. RESULTS: The age group 21-30 years was most frequently involved. Sex preponderance was 4.3:1 (male: female). Twenty-six patients had normal CT scans. The most common abnormal finding was intracerebral hemorrhage 35 cases (33%). This was followed by skull fractures, 23 cases (31%); subdural hemorrhage, 16 cases (21%); cerebral edema, 11 cases (15%). Others included mass effect, nine cases (12%). CONCLUSION: CT plays a very significant role in management of head injuries, as demonstrated in this study, by making such diagnoses that guided eventual patient management. Intracerebral hemorrhage was the most common abnormal finding in this report. Regular use of CT in moderate to severe cases of head injury is advocated.

An audit of 3859 preadmission chest radiographs of apparently healthy students in a Nigerian Tertiary Institution.

BACKGROUND: Chest radiographs are routinely requested as part of the medical screening process prior to admission to institutions. Literature on the yield of such an exercise is sparse especially in the Nigerian setting. This study was therefore carried out to assess the usefulness of routine chest radiography for students at the time of admission. MATERIALS AND METHODS: This was a prospective study of 3859 chest X-rays taken at the department of radiology, University of Benin Teaching Hospital for one admission screening for the 2008/2009 academic year. The age and sex of the subjects were also recorded. The heart, lung fields and bony thorax were examined for any abnormality. RESULTS: Out of the 3859 pre-admission chest radiographs studied, there were 1951 males or 50.56% and 1908 females or 49.44% subjects. The mean age for males was 21.15±3. CONCLUSION: This study has shown that pre-admission routine chest radiography in asymptomatic patients remains a relevant screening tool for medical fitness during admissions into institutions. However because of dangers of exposure to ionizing radiation, we advise that a detailed medical history and physical examination be done to restrict its use to only those subjects with signs and symptoms suggestive of disease.

Residents' perception of postgraduate radiology training in Nigeria.

BACKGROUND: literature on radiology residency in Nigeria is sparse, even for decades after its commencement. There is therefore the need to inquire into the problems and prospects of the programme, at least from the perspectives of the residents. OBJECTIVE: to determine residents' perception of the radiology residency programme, residents' view on state of facilities, and their opinion on the future of radiology training in Nigeria. METHODS: Self-administered semi-structured questionnaires, were given to residents to complete. Contacts were made with residents during update courses and radiologists' conferences or meetings. RESULTS: one hundred and twenty-five questionnaires were given out and 120 were completed and returned, giving a response rate of 96 %. Fifty-eight (48%) respondents mentioned academic interest as the major influencing factor for enrolling into the programme. Only 20 (16%) residents had made up their minds to do radiology residency as medical students. All the residents identified conventional radiography and ultrasound as the only regularly functioning modalities in their centres, while 72 (60%) respondents mentioned same for cross sectional imaging modalities; that is CT and MRI. One hundred and ten (90%) respondents had rotation through available modalities as the plank of their training programmes, and 96 (80%) did not feel happy about the state of teaching aids at their centres. Ninety-six (80%) of the residents expressed satisfaction at the efforts of the supervisory postgraduate medical colleges at organising update courses. Eighty respondents (65%) mentioned limited (or lack of) exposure to modern imaging modalities as the greatest threat to the future of radiology residency in Nigeria. CONCLUSION: nigerian radiology residents are concerned about lack of modern imaging tools, facilities at their centres, as well as opportunities for exposure overseas, and the likely impact of these on their training and the future of the specialty in Nigeria.

Contact tracing/pre-employment screening for pulmonary tuberculosis: should positive Mantoux test necessitates routine chest X-ray?

BACKGROUND: Pulmonary tuberculosis (PTB) remains a scourge in most developing countries. Mantoux skin test and more commonly chest radiography are some of the methods of diagnosing the disease, especially with regard to contact tracing and pre-employment screening. Regular use of radiography has both safety and cost implications. This study aimed at establishing if any justification exists in requesting for chest radiographs in asymptomatic subjects with a positive Mantoux skin test reaction. METHODS: 174 adults comprising PTB contacts and newly employed/admitted university staff/students were recruited into the study. They were 89 males (51.1%) and 85 females (48.9%). All subjects had Mantoux test (using purified protein derivative, PPD). Patients who had positive Mantoux reaction subsequently were subjected to posteroanterior chest radiographic examination. Mantoux test and chest radiographic findings were then correlated with each other. RESULTS: 102 subjects (59.2%) had positive Mantoux reactions, while 27 subjects (31.1%) had abnormal chest radiographs. There was no significant correlation between Mantoux readings and chest radiographic findings (P=0.106). CONCLUSION: It is concluded that other ancillary tests like sputum examination and/or, where available, Interferon and ESAT tests should be carried out before chest radiograph is requested in subjects with positive Mantoux reaction.

Profile of post-traumatic epilepsy in Benin City, Nigeria.

BACKGROUND: Post traumatic epilepsy is recurrent chronic seizures occurring after four weeks following brain injury. It commonly occurs after road traffic accidents thus making it a preventable cause of chronic seizures. The prevalence and pattern of this disorder is not known among Nigerian patients with epilepsy. OBJECTIVE: This study aimed at determining the prevalence of and predisposing type of head injury to developing post traumatic epilepsy. METHODS: We studied 244 consecutive patients with epilepsy attending the neurology clinic of a tertiary health facility in an urban Nigerian city by analyzing the details of their demographic and clinical data obtained with the aid of a structured questionnaire and from the Epilepsy Registry of a Neurology Unit between January and December 2006. RESULTS: Thirty-eight patients with a mean age of 38.6 +/- 7.3 years (age range 15- 75 years) had posttraumatic epilepsy comprising 15.57% of all cases of epilepsy. Thirty-three (86.8%) had closed head injury. Thirty-two (84.2%) of the patients had positive history of loss of consciousness. Twenty two patients (57.9%) sustained head injury from motor vehicle accidents. Majority of the patients had secondarily generalized seizures (73.7% of the cases). Twenty-seven (71.4%) of the 38 patients had seizure onset in the first year after brain injury. Depressed skull fracture (19/38; 50%) was the most common abnormal CT finding. CONCLUSION: Post traumatic epilepsy contributes significantly to the number of patients with epilepsy presenting to our neurology services. There is need to educate people on the usefulness of seat-belts and helmets while driving.

Multiple intracranial tuberculomas in an HIV-negative 28 year old male--a case report.

Intracranial tuberculomas are uncommon complications of tuberculosis, especially in immuno-competent individuals with no evidence of extra-cranial foci. We report a case of an HIV- negative young male who presented with presumed cerebral and cerebellar tuberculomas without identifiable extra-cranial focus. The CT scan revealed multiple intracranial ring-enhanced lesions. The remarkable response to antituberculous drugs and steroid (prednisolone) with near complete resolution of clinical and radiological signs was highly suggestive of diagnosis. In the differential diagnosis of intracranial mass lesions in sub-Saharan Africa, a high index of clinical suspicion is needed to avoid misdiagnosis of intracranial tuberculoma.

Acute renal impairment following use of intravenous contrast agent: A case report and reminder for increased awareness of the problem.

OBJECTIVE: Contrast-induced nephropathy is one of the adverse reactions to the use of radiocontrast media. Its incidence can be reduced if preventive measures are instituted. This report presents a case of acute renal impairment following use of radiocontrast media. PATIENT, METHOD AND RESULTS: We report a case of an elderly hypertensive diabetic who developed acute renal impairment within 24 hours of undergoing an intravenous urography. He was not a known asthmatic and had no previous history of allergy. His renal function improved subsequently with hydration, diuretics and strict input/output monitoring. He was discharged after 23 days in hospital and renal function returned to pre-morbid state 3 months after discharge. CONCLUSION: The report is a reminder of the possibility of nephropathy associated with the use of intravascular contrast media. There is need for extra care to be taken to identify risk factors in patients that are to undergo intravascular contrast studies and adequate attention paid to these.

Ultrasound assessment of renal size in healthy term neonates: a report from Benin City, Nigeria.

Knowledge of the normal range of renal size is useful in appreciating variations that may occur due to morbidities. Ultrasound is a simple and safe method of evaluating renal sizes in all age groups. This is a prospective study of the assessment of renal dimensions in apparently healthy neonates at the University of Benin Teaching Hospital, Nigeria. One hundred and fifty neonates were studied, including eighty-five males (56.7%) and sixty-five females (43.3%). The mean length of the right kidney was 44.9 +/- 3.2 mm and the mean length of the left kidney was 44.4 +/- 3.5 mm. The difference in renal length between the two sides was not statistically significant. The height and weight of the child showed strong correlation with longitudinal renal measurements. The study also showed the independence of neonatal renal sizes on gender and race.

Urethral fibrosis with pyonephrosis in a patient with situs inversus totalis: a case report.

BACKGROUND: Cases of a case of situs inversus totalis are very rare and therefore when encountered, they are likely to be missed or poorly managed. OBJECTIVE: To present a case of situs inversus totalis with a view to creating more awareness about this rare clinical entity. PATIENT AND METHOD: The patient, a 22 year old boy was referred from a private clinic after a failed and complicated attempted appendicectomy carried out by a general medical practitioner. The patient was admitted, resuscitated and had investigations done. Some of the investigations done were abdominal ultrasound scan, computerized axial tomography scan, a chest x ray, complete blood count, urinalysis and electrolyte and urea. RESULTS: Investigations showed features of situs inversus totalis. There was also bilateral hydronephrosis, worse on the right side. The patient also had features of renal failure. He died after three days on admission. Autopsy finding confirmed bilateral pyonephrosis which was worse on the right side. There was associated urethral fibrosis. Cause of death was urethral fibrosis resulting in obstructive uropathy, pyonephrosis and renal failure. CONCLUSION: Situs inverses totalis is rare but can psented in diverse ways and thus the diagnosis may be missed and the patient wrongly managed. A high index of clinical suspicion is required if we the diagnosis is to be made early and wrong treatments avoided.

Dextrocardia with situs inversus: a case report.

We present a 24-year-old lady who reported at the radiology department, UBTH Benin City for a chest radiograph, as part of her pre-employment medical examination. She was asymptomatic, her past medical history was not significant and physical examination revealed an apex beat located on the 5th right intercoastal space. The chest radiograph confirmed dextrocardia and also revealed the gastric air bubble on the right, which was suggestive of situs inversus totalis. Barium meal examination confirmed the right-sided position of the stomach, in keeping with situs inversus. Ultrasonography revealed a left sided liver and gall bladder, with a right sided location of the spleen.

A post rotation survey of medical students attitude to radiology.

The objective of the study is to determine the effect of a three-week radiology rotation on the attitudes and knowledge of medical students about the specialty. It was found that the students believed in the relevance of radiology in the medical school curriculum and its importance to future medical practice. There was acceptable level of awareness of radiation protection. However, the rotation failed to change the misconception of Radiologists enormous workload with resultant bias to the specialty. It is concluded that the rotation had a mixed effect on student's knowledge and perception of radiology. This finding is comparable with other studies done in industrialized countries. Measures aimed at improving the unfavourable attitudes are suggested.