Indications for ultrasound in the evaluation of the pathological scrotum.

Scrotal ultrasound scans carried out on 156 patients were reviewed in a retrospective study and the sonographic findings and indications evaluated. Ultrasound was able accurately to distinguish the normal from the pathological scrotum. Extratesticular lesions were readily differentiated from testicular lesions. Abnormal testicular echo patterns were usually associated with tumours, but orchitis, granulomas and haematomas were found to have a similar appearance. Occult testicular tumours could readily be identified. Ultrasound was also useful in excluding underlying pathology in hydroceles, in the diagnosis and follow-up of epididymitis and other epididymal lesions and in the assessment of underlying testicular damage in traumatic haematoceles. Ultrasound may also be useful in post-orchiectomy follow-up examinations to exclude tumour in the contralateral testis.

Ultrasonic diagnosis of abdominal disease in Kenya.

This study presents the results of abdominal ultrasonic scanning in 108 patients attending a tropical referral hospital. Clinical diagnoses included hepatocellular carcinoma, metastatic liver disease, amoebic liver abscess, hydatid disease, obstructive jaundice, hepatosplenomegaly of uncertain aetiology and renal cysts and tumours. Because of its ability to distinguish solid from fluid-filled lesions, we found ultrasonic scanning the most useful initial investigation for the differentiation of hepatic masses. Ultrasonography is also ideal for the diagnosis of abdominal cysts and is extremely reliable in differentiating extrahepatic from intrahepatic obstructive jaundice. It is a non-invasive procedure, quick and easily repeatable and has great potential in tropical medical practice.

Ultrasonic diagnosis of abdominal hydatid disease in Kenya.

Hydatid disease is common in Kenya. Established diagnostic methods are not entirely satisfactory and this study was undertaken to show the value of ultrasound in the diagnosis of abdominal hydatid disease. The sizes, numbers and sites of hydatid cysts have been shown in 16 patients. In view of its accuracy, lack of radiation hazard and relative cheapness, ultrasound is recommended as the method of choice for the investigation of abdominal hydatid disease.

Diverticular disease, carcinoma of the colon and diet in urban and rural Kenya Africans.

20 cases of diverticular disease and 12 cases of carcinoma of the colon have been demonstrated in 183 barium enemas in 1 year. These results, along with a dietary survey, show that diverticular disease can no longer be considered rare in Kenyan Africans and that a low-fibre diet is a contributory but perhaps not the only factor in its aetiology. There is probably an increasing incidence of diverticular disease as well as an increasing recognition of it. The incidence of carcinoma does not appear to be increasing to the same extent.

The cholecystokinin test: an assessment.

A cholecystokinin (CCK) test was performed on 13 female patients who were thought to be having attacks of gallbladder pain and in whom at least one cholecystogram had been normal. In 10 of these patients the CCK test was performed during the course of a repeat cholecystogram in order to assess the effect of CCK on gallbladder contraction. There was no constant relationship between a positive test and gallbladder contraction as measured radiographically. Cholecystectomy was undertaken in 9 patients and of these, 4 had been CCK positive, 4 had been CCK negative and 1 had reacted equivocally. None of the CCK positive patients had stones at operation, whereas 2 of the CCK negative patients had one or two small stones. In this small series cholecystectomy relieved both the CCK negative and CCK positive patients of pain with equal frequency. It is concluded that a negative CCK test by no means excludes the presence of symptomatic gallstones in patients with X-ray negative gallbladder pain.