A Comparative Study of Uterine Artery Doppler Parameters and Endometrial Characteristics in Women with Unexplained Infertility and Fertile Women at a Nigerian Teaching Hospital.

OBJECTIVES: To investigate the uterine artery Doppler parameters and endometrial characteristics in women with unexplained infertility. METHODS: A prospective case-control study of 42 women with unexplained infertility and 42 fertile controls. Their mid-luteal phase transvaginal Doppler parameters of both uterine arteries and endometrial characteristics (endometrial blood flow, thickness and volume) were investigated and analysed. P values < 0.05 was statistically significant. RESULTS: The mean uterine artery pulsatility index (PI) and resistivity index (RI) of the cases (women with unexplained infertility) were significantly higher compared to the values in the fertile controls (PI = 2.81±0.61 vs 2.15±0.65; p=0.001) (RI= 0.87±0.08 vs 0.82±0.07; p=0.003). In addition, the end-diastolic volume (EDV) (6.12±4.17 vs 9.37±5.14; p=0.007) and endometrial-subendometrial blood flow (p=0.036) were significantly lower in the cases compared to the controls. Multivariate logistics analysis showed that PI was independently associated with infertile status (p=0.006). There was no significant difference in the mean PSV (48.69±10.9 vs 50.58±11.30; p=0.602), endometrial thickness (10.30+3.13 vs 10.72+3.10; p=0.544), endometrial volume (7.82+1.56 vs 8.23+1.71; p=0.323), mean age (32.28±4.062 vs 31.91±3.58 years; p=0.502), body mass index (26.15±2.71kg/m2 vs 25.24±2.85 kg/m2; p=0.18) menstrual bleeding days (4.07±0.89 days vs 4.02±0.95 days; p=0.481) duration of menstrual cycle (28.02±1.09 days vs 27.64±1.36 days; p= 0.162), smoking history (p=0.909) and alcohol intake (p=0.507) of the infertile women compared with the fertile controls, respectively. CONCLUSION: Women with unexplained infertility have increased uterine artery Doppler PI and RI and reduced endometrial-subendometrial perfusion compared with fertile controls.

OBJECTIFS: Étudier les paramètres Doppler de l'artère utérine et les caractéristiques de l'endomètre chez les femmes atteintes d'infertilité inexpliquée. MÉTHODES: Une étude cas-témoins prospective de 42 femmes atteintes d' infertilité inexpliquée et 42 témoins fertiles. Leur phase mi-lutéaleles paramètres Doppler transvaginaux des artères utérines et des caractéristiques de l'endomètre (flux sanguin de l'endomètre, épaisseur et volume) ont été étudiés et analysés.Les valeurs P d ¼ 0,05 étaient statistiquement significatives. RÉSULTATS: L'indice moyen de pulsatilité de l'artère utérine (IP) etindice de résistivité (IR) des cas (femmes atteintes d'infertilité inexpliquée)étaient significativement plus élevées par rapport auxvaleurs des témoins fertiles(PI = 2,81±0,61 vs 2,15±0,65; p = 0,001) (RI = 0,87±0,08 vs0,82±0,07; p=0,003). De plus, le volume diastolique final (EDV)(6,12±4,17 vs 9,37±5,14; p = 0,007) et endométrialesous-endomètrele débit sanguin (p = 0,036) était significativement plus faible dans les cas comparésaux contrôles. L'analyse logistique multivariée a montré que PI était indépendamment associé au statut infertile (p = 0,006).Il n'y avait pas de différence significative dans le PSV moyen (48,69±10,9 vs50 h 58±11 h 30; p=0,602), épaisseur de l'endomètre (10,30+3,13 vs10.72+3.10; p = 0,544), volume de l'endomètre (7,82 + 1,56 vs 8,23 + 1,71;p=0,323), âge moyen (32,28±4,062 vs 31,91±3,58 ans; p=0,502),indice de masse corporelle (26,15±2,71 kg/m2 vs 25,24±2,85 kg/m2; p=0,18)jours de saignements menstruels (4,07±0,89 jours vs 4,02±0,95 jours; p = 0,481)durée du cycle menstruel (28,02±1,09 jours vs 27,64±1,36 jours;p= 0,162), antécédents de tabagisme (p = 0,909) et consommation d'alcool (p = 0,507)des femmes infertiles par rapport aux témoins fertiles, respectivement. CONCLUSION: Les femmes atteintes d'infertilité inexpliquée ont augmentation significative de l'artère utérine Doppler PI et RI et réduction perfusion endométriale-sous-endoudo-endométrique par rapport aux témoins fertiles. Mots-clés: Infertilité inexpliquée, Artère utérine, Doppler, Caractéristiques de l'endomètre.

Diagnostic accuracy of tru-cut biopsy of breast lumps at University College Hospital, Ibadan.

BACKGROUND: Tru-cut needle biopsies form an integral part of Triple assessment of breast cancer and include clinical assessment, mammography and core needle biopsy. No study has been done to evaluate the validity of the procedure in our environment. This study was done to evaluate the validity of core needle biopsies in our centre. METHOD: A retrospective study of patients with tru-cut needle biopsies of breast lumps and follow-up excisional biopsy or mastectomy done in the Department of Surgery, University College Hospital, Ibadan over a ten year period was done. Fifty one patients who fulfilled the inclusion criteria had their records obtained from the Department of Pathology. The diagnosis was classified into benign and malignant with the excisional biopsy or mastectomy diagnosis used as the gold standard. The sensitivity, specificity and accuracy were calculated and kappa was also done to evaluate the degree of agreement. RESULTS: A total of 51 cases were included in this study. The average age of the patients was 47 ± 13 years with a range from 19 to 81 years. Thirty of the biopsies (59%) had a definitive diagnosis of malignancy while twenty one (41%) were benign. The overall sensitivity, specificity and accuracy were 86%, 71% and 80.4% respectively. The specificity of malignant biopsies was 68% while benign was 35%. The level of agreement for malignant biopsies was higher than benign biopsies with a kappa of 0.39 for malignant diagnosis as against 0.29 for benign. CONCLUSION: Tru-cut needle biopsies have a comparable sensitivity and specificity to excisional biopsies. Diagnostic accuracy can be further enhanced with the adoption of image guided biopsies.

Complications of chronic sinusitis on orbital sonography and craniofacial computed tomography--a case report.

A 15-year-old boy without a previous history of sinusitis presented with life threatening complications from chronic pansinusitis. This report highlights the role of ultrasound and computed tomography (CT) in the diagnosis and management of occult sinusitis and its complications.

Experience with three-dimensional computed tomographic angiography in Ibadan, Nigeria.

INTRODUCTION: The latest versions of spiral CT scanners have provided the radiologist with unparalleled capabilities for vascular imaging. Computed Tomographic Angiography (CTA) has the potential of revolutionizing vascular imaging and with evolving improvements may replace conventional angiography in the near future OBJECTIVE: To report our initial experience with CTA in Nigeria; highlighting its usefulness as a non invasive modality and its clinical applications in diagnosis of vascular abnormalities of various parts of the body. MATERIALS AND METHODS: We reviewed 62 patients who had CTA between December 2003 and September 2005.. The studies were performed using a spiral technique with GE CT/e single-slice scanner (General Electric Medical Systems) having a gantry rotation period of one second. Details of techniques of data acquisition, methods of 3-D reconstruction and clinical applications are discussed. RESULTS: Vascular abnormalities were demonstrated in 26 (42%) patients including 5 cranial arteriovenous malformations (AVMs), 3 intracranial aneurysms, 1 spinal AVM, 3 aortic aneurysms, 5 carotid artery stenosis, and 2 traumatic peripheral aneurysms. CONCLUSION: Correlations between CTA and surgical findings were good. CT angiography has enhanced our practice of vascular radiology in Ibadan as it has done in the west and other parts of the world.

A 5-YEAR REVIEW OF ULTRASONOGRAPHIC EVALUATION OF OCULAR DISEASES AT THE UNIVERSITY COLLEGE HOSPITAL IBADAN, SOUTH-WEST, NIGERIA.

BACKGROUND: Orbito-ocular diseases are a major public health issue, often causing visual impairment with serious socioeconomic implications on individual lives. Ocular ultrasonography is an invaluable diagnostic tool when clinical examination of the ocular fundus is difficult. OBJECTIVES: To describe the indications, sonographic findings, and contribution of orbito-ocular ultrasonography to the management of orbito-ocular diseases in the University College Hospital, Ibadan. MATERIALS AND METHODS: A retrospective review of B-mode ocular ultrasound findings and hospital data of all patients referred to the Radiology department of the University College Hospital, Ibadan for ocular Ultrasound between January 2014 - December 2018. RESULTS: There were 142 patients, aged 1-85 years, (median age =28 years). 72 (50.7%) patients were under 30 years of age, and 50 (35.2%) were pediatric cases. Male to female ratio was 1.84:1. The commonest presenting complaint was blurred vision in 97 (68.3%) cases, followed by eye trauma in 54 (38.0%). B-mode Ultrasound, demonstrated cataract in 63 (44.4%,) cases, vitreous hemorrhage in 42 (29.6%), retinal detachment in 27 (19.0%), vitreous detachment in 19 (13.4%), normal findings in 17 (12%) and orbital tumors in 13 (9.2%) patients. B-mode ultrasound scan and clinical diagnosis demonstrated good agreement in 91 /142 cases (64.1%), partial agreement in 23/142 (16.2%) cases, and no agreement in 28 (19.7%). Kappa agreement scores, K were 74.3% and 70.9%, for ruptured globe and cataract respectively. CONCLUSION: Orbito-ocular ultrasonography contributes significantly to the diagnosis of orbito-ocular disease and shows good correlation with clinical diagnoses. However, a future study with larger numbers is required.

Superior vena cava obstruction: diagnosis, management and outcome.

OBJECTIVE: To document our experience with superior vena cava obstruction in a black African population. DESIGN: A retrospective study of clinical data collected from cancer registry, patients case noted, cardiothoracic surgical unit's and operating records between June 1975 and May 1999. SETTING: University College Hospital, Ibadan, Nigeria which hosts a major cancer centre in the West African sub-region and also serves community clinics. PATIENTS: All patients with superior vena cava (SVC) obstruction referred for evaluation and treatment. MAIN OUTCOME MEASURES: Patients who had clinical features related to SVC obstruction and full investigation including tissue diagnosis were collated. Methods of treatment of acute episodes, definitive treatment and outcome of SVC obstruction were studied. RESULTS: One hundred and twenty nine consecutive patients with SVC obstruction were treated. There were 100 males and 29 females. Mean age was 36 +/- 15 years. The annual incidence increased from 2.3 patients per year during the first 12 years to 8.4 patients per year during the second 12 years. The most common symptoms were swelling of face, arms and chest-wall (87.6%) with associated venous congestion over these areas. Majority of the patients (73.8%) presented within 1 to 12 months of onsets of symptoms. Patients with benign diseases had longer duration of symptoms before presentation (mean 3 months) than those with malignant disease (mean 6 months). Majority of the patients (82.2%) had malignancy as the underlying cause of the SVC obstruction and 47.2% of the malignancy was bronchogenic carcinoma. Symptomatic relief and outcome was best in benign disease (7 out of 8 patients, 87.5%). Lymphomas had better outcome than bronchogenic carcinoma among the patients with malignant diseases. CONCLUSION: Patients with SVC obstruction should be carefully evaluated before treatment. This will enhance application of specific therapy.

Cranial computed tomographic (CT) findings in HIV-positive Nigerian patients presenting for neurosurgical evaluation.

INTRODUCTION: The central nervous system (CNS) is an important site of HIV infection. As many as one quarter of AIDS patients present with neurological symptoms and up to 75% of the patients may have CNS abnormalities at autopsy. Under these circumstances therefore, differential diagnoses in HIV-positive patients with neurological symptoms constitute a management challenge. OBJECTIVE: To describe the pattern of cranial computed tomographic (CT) findings in neurosurgical patients with HIV infection. STUDY DESIGN: Retrospective analysis. PATIENTS AND METHOD: A total of 1907 patients were admitted from October 1996 to October 2001. Sixteen patients were positive for HIV using the Western blot. We reviewed their biodata, clinical features and cranial CT findings. RESULTS: There were 10 male and 6 female patients. Twelve patients had cranial CT. Four patients had lesions that could be attributed to direct infection by HIV virus. Two patients had lesions that suggested immunosuppression from HIV infection. Diffuse breakdown in blood brain barrier (BBB) with contrast enhancement as well as mass effect that was disproportional to the enhancing lesion were common findings in three patients. The other lesions seen on cranial CT could not be directly linked to HIV infection. CONCLUSION: Apart from the diffuse breakdown in blood brain barrier with disproportional mass effect, our findings were similar to previous reports. Further study with a larger population of patients and, especially, biopsy of the CNS lesion will be needed to confirm our findings.

Bilateral congenital cystic adenomatiod malformation of the lungs: a case report.

A six weeks old infant presented with scalp ulcer and fever. and on examination was found to have resonant percussion notes bilaterally. The initial chest radiograph revealed multiple lucencies which were initially thought to be due to diaphragmatic hernia, but the dilemma was resolved by Computerised tomography which revealed the lucencies to be multiple cysts characteristics of Congenital Cystic Adenomatiod Malformation (CCAM) type II.

Solitary intracranial tuberculoma in patients without immuno-suppression: a report of three cases.

BACKGROUND AND OBJECTIVE: Poverty, drug resistance and the advent of human immunodeficiency virus infection (HIV) have led to a recent upsurge in the incidence of tuberculosis including intracranial tuberculosis. In this article, we report 3 patients who had solitary brain tuberculomas and were otherwise healthy to underscore the importance of continuing vigilance for this disease. CASE REPORTS: Three patients (57 years, female; 52 years, male; 7 years male) presented to our unit with features of intracranial tumours. They were all HIV negative with no previous history of tuberculosis. Cranial computed tomography scans demonstrated uniformly contrast enhancing falcine supratentorial masses in the adult patients and a cerebellar hemispheric lesion with peripheral contrast enhancement in the paediatric patient INTERVENTION: All the patients had gross total tumour excision. The histology confirmed a tuberculoma. They all had antituberculous therapy after histological confirmation. The outcome was good in all the patients. CONCLUSION: Intracranial tuberculoma can occur in otherwise healthy individuals and should always be considered in the differential diagnosis of solitary intracranial mass lesions in sub-Saharan Africans so that minimally invasive procedures can be used to establish the correct diagnosis.

Computed tomographic pattern of stroke in children with sickle cell anaemia in Ibadan.

We present the findings in 14 paediatrics patients with SCA who had CT examination at the University College Hospital Ibadan on account of stroke between 1993 and 2000. There were 8 female and 6 male with a mean age of 11.25 years and SD of 3.66. Cerebral infarction was the most common finding occurring in 57% of the patients while intracerebral bleed was seen in 21%. Two patients had a mixed lesion and atrophy was seen in one patient. Five patients (36%) had their lesion on the right hemisphere while eight (57%) had their lesions on the left side. The frontal and parietal lobes were mainly affected. Prompt CT screening of the brain in a child with sickle cell anaemia who presents with symptoms and signs suggestive of stroke can help identify the particular type of lesion and this may influence mode of therapy given as well as prognosis

Trans-hiatal oesophagectomy as palliative treatment for carcinoma of the oesophagus.

OBJECTIVE: To determine the role of palliation with trans-hiatal oesophagectomy in Nigerian patients with carcinoma of the oesophagus. DESIGN: Prospective case series. The first series was from February 1986 to September 1987 (Series A) while the second series was from March 1989 to November 1996 (Series B). SETTING: Cardiothoracic Surgery Unit (CTSU) of the University College Hospital, Ibadan, Nigeria. SUBJECTS: First series consisted of 10 consecutive operable patients with carcinoma of oesophagus seen over the period of study. The second series consisted of 21 consecutive patients with same disease. INTERVENTION: All patients had transhiatal oeosphagectomy by a two team approach and immediate placement of the freed stomach in the posterior mediastinum and cervical oesophagogastrostomy. RESULTS: Patients in both series had a comparable age range of 43 - 80 years for series A and 40 - 82 years for Series B. The duration of symptoms were 2 - 6 months and 2 - 12 months respectively, for series A and B. In series A, nine patients had carcinoma of the middle-third (M1/3) of the thoracic oesophagus and one patient had carcinoma of lower-third (L1/3) of the thoracic oesophagus. In series B, 18 patients had M1/3 and three patients had L1/3 lesions. Average blood loss in series A was 1,067 mls, corresponding value for series B was 852 mls. Postoperatively, all cases were classified as stage III or stage IV disease. There were 18 complications in eight patients in series A and 22 complications in 10 patients in series B. The commonest complications in series A were pleural enteries in six patients, haemorrhage four patients (three intraoperative, one post-operative) and respiratory failure (two patients). The commonest in series B were pleural enteries in nine patients, anastomotic leaks and stenosis in four patients and respiratory failure in three patients. Hospital mortality was 50% in Series A and 14.3% in series B. The causes of death were haemorrhage and respiratory failure in series A, respiratory failure in series B. Survival period in series A of the five patients discharged was for a median of 84 months, for series B, four patients were alive at 18 months post-operative, one patient attended follow-up clinic 24 months after surgery. No other adjunctive therapy was offered to the patients. CONCLUSION: Trans-hiatal oesophagectomy is a procedure suitable for patients with carcinoma of the oesophagus and affords palliation at an "acceptable price" among carefully selected patients with advanced carcinoma of the oesophagus.

Presentation of primary mediastinal masses in Ibadan.

OBJECTIVES: To determine clinical features, anatomic location and histological types of primary mediastinal masses diagnosed and treated in a black African population. DESIGN: A retrospective study of clinical data collected from patients case notes, the cardiothoracic unit's and pathology records between June 1975 and May 1999. SETTING: University College Hospital, Ibadan, Nigeria which hosts a major cancer center in the West African sub-region, and serves community clinics. PATIENTS: All patients with primary mediastinal masses referred for evaluation and treatment. MAIN OUTCOME MEASURES: Excluded metastatic, oesophageal and vascular-lesions. All patients had radiological evalulation and tissue biopsies. The anatomic subdivision of the mediastinum into anterosuperior, middle and posterior section was used. RESULTS: One hundred and five consecutive patients were evaluated and treated. The mean age was 34.0 +/- 20.4 years. There were 75 males and 30 females. Eighty one (77.1%) were symptomatic, 24 (22.9%) were asymptomatic. Thirty seven (45.7%) of the symptomatic patients had malignant disease while 44 (54.3%) had benign disease. Forty five patients (43%) and 60 patients (57%) had malignant and benign diseases respectively. Incidence of symptoms, was 82.2% for malignant and 73.3% for benign diseases. This difference in incidences is statistically insignificant (p=0.283). Majority of asymptomatic patients (70.8%) had benign disease while 29.2% of patients with malignancy were asymptomatic. This difference in incidence was statistically significant (p=0.0039). The frequency of mediastinal masses were anterosuperior, in 67 patients (63.8%), posterior mediastinal, 24 patients (22.9%) and middle mediastinal in 14 patients (13.3%). Lymphoma 23 (21.9%), thymus glands tumours 19 (18.1%) and endocrine tumours (goiters) 18 (17.1%) were the commonest types of primary mediastinal masses treated. CONCLUSION: Majority of our patients with mediastinal masses (whether benign or malignant) are symptomatic and the absence of symptoms is more associated with benign disease. Majority of lesions are situated in the anterosuperior mediastinum. Lymphoma is the most frequent primary mediastinal mass.

Cholelithiasis in Ibadan: an update.

This study is to ascertain the present status of cholelithiasis in our environment. Six hundred and seventy (670) consecutive abdominal, ultrasounds done for various abdominal complaints at the University College HospitaL Ibadan from January 1977 to December 1998 were studied for gall stones in addition to other studies of the abdomen. Only twelve (12) gallstones were found, giving a prevalence of 1.79%. Only 25% were silent stones. The male:female ratio was 1:3. The mean age was 30 years (S.D = 2.8) and peak age was between 30 and 40 years. The average body mass index (B.M.I) was 23.49 kg/m2 (S.D = 3.9). The average parity among the women was four (4). Only one ultrasound was false (false negative). This study shows an increase. In prevalence over previous figures (1.79%) as against 0.007% in the sixties). The peak age is a decade lower and the anthropometric measurements in our patients do not support the typical caucassian model.

Radiological evaluation of head trauma by computer tomography in Ibadan, Nigeria.

The computed tomography (CT) findings of 419 patients with head injury were reviewed. 254 (60.62%) showed abnormal CT findings while 165 (39.38%) had a normal CT examination. Pathological states, which were easily demonstrated by CT, include traumatic haemorrhages (i.e. intracerebral bleed 67 cases (26.3%), Subdural haematoma 73 cases (28.7%), cerebral oedema and other cerebral sequelae of trauma such as porencephalic cysts, cerebral infarction and leukodystrophy. Patients with focal neurological deficit showed more positive findings than those without. A total of 73 (17.42%) patients had fractures demonstrated on CT. 39 (23.2%) of the 168 patients with traumatic haemorrhages had associated fractures. Fractures were detected more in patients with intracerebral and epidural haemorrhages than subdural haemorrhages. Plain skull radiography alone is therefore not sufficiently valuable in investigating patients with head injury. Computed tomography, no doubt, offers an excellent method of investigating the patient with head injury in that it demonstrates intracranial or cerebral lesions that may or may not be associated with fractures; and which might be missed if CT is not done. CT examination should be obtained where it is available if clinical indication warrants it and when CT is to be done, plain films are irrelevant since CT with bone window settings and with 3D reformation would show fractures.

Computerised tomographic detection of intracranial complications of paranasal sinus infections.

Ninety-four patients were referred for CT examination of the paranasal sinuses within a five year period. Only 11 (11.7%) of them had intracranial complications. These include cerebral, subdural and epidural abscesses, frontal bone osteomyelitis. The maxillary and ethmoidal sinuses were mostly involved and can be implicated as the sinogenic causes of intracranial infections. Sphenoidal sinus was not involved in any of the patients.

The place of clinical features and standard chest radiography in evaluation of mediastinal masses.

One hundred and five primary mediastinal masses were seen between 1975 and 1998, at the Cardiothoracic surgical Unit of the University College Hospital Ibadan. These were studied to establish the importance of clinical features and plain chest radiography in preoperative evaluation of these masses. The sources of information were unit's record, cancer registry and the patients case note. The age range of the 75 male patients was 3 to 80 years (mean 35.2 +/- 22.1 year) and for the 30 female patients was 2.5 to 70 years (mean 30.9 +/- 18.6 years). Anterosuperior mediastinal masses were the most common (63.8%) followed by posterior mediastinal masses (22.9%). Middle mediastinal masses made up the remaining (13.3%). The most common primary mediastinal tumour was lymphoma (21.9%) next to which were thymus gland neoplasia and thymus cysts/hyperplasia (18.1%). Endocrine tumours (mainly goiters) constituted 17.1% of the masses. On the whole, 45 (42.9%) of the mediastinal tumours were malignant and 60 (57.1%) were benign. Eighty one patients (77.1%) were symptomatic at presentation, 24 patients (22.9%) were asymptomatic. Malignancy was more associated with symptoms in this series (82.2%) and benign lesion were more frequently (70.8%) asymptomatic. Cervical lymphadenopathy (78.6%), was more frequent in patients with malignant lesion. Tracheal deviation (60.3%) and neurological signs (78.9%) were more frequent in benign disease. Superior vena cava syndrome was more frequently associated with primary malignant mediastinal tumours. All masses (100%) were visualized on plain chest x-ray. On the basis of clinical features and chest x-ray, majority of patients (76.2%) with primary mediastinal masses had exploratory thoracotomy, sternotomy or biopsy of their mediastinal mass.

Computed tomographic evaluation of TB spine in Ibadan.

BACKGROUND: Tuberculosis still remains a major problem in the developing countries. The involvement of the spine is also of increasing importance, because of the resurgence of TB in association with AIDS. This paper is designed to evaluate the applicability of CT in the diagnosis and definition of tuberculosis of the spine in Ibadan. METHOD: A restrospective study of the Computed Tomographic examination of 22 cases of spinal tuberculosis (Pott's disease) over a four-year period at the Radiology Department of the University College Hospital, Ibadan. RESULTS: There was a male prevalence in the study. The mean age of respondents was 41.2 years. Neurological symptoms and back pain were the most common presentations. The thoracic spine was mostly involved while the cervical spine was least involved. Most lesions 77.3 % were demonstrated in two contiguous vertebral bodies. The vertebral bodies were destroyed in all the patients while the posterior elements were involved in 59%. The other CT findings were paravertebral soft tissue shadow in 40.9%, narrowed irregular disc spaces in 27.3% and fusion of vertebral bodies in 13.6%. The frequent bony destruction was osteolytic in nature, and was present in 64% of patients. CONCLUSION: CT is an adequate modality for thorough imaging and diagnosis of Pott's disease especially in patients with non specific or ambiguous presentations. It offers a unique opportunity of demonstrating clearly the various component of the spine, it also defines the pattern and extent of the destructive process.

Computed tomographic evaluation of Pott's disease in Accra.

BACKGROUND: Radiological investigations are central in the diagnosis and management of TB spine. In Ghana there is a dearth of literature on the disorder. This paper seeks to describe the CT features of the bony and soft tissue changes in Pott's disease. METHOD: It is a descriptive report of the CT scans performed on 30 patients with proven Pott's disease from January 1998 to December 2000 at the Korle Bu Teaching Hospital Accra, Ghana. RESULTS: The disorder was common among children and young adults (76.7%). Chronic back pain was the frequent presenting complain (53.3%). The dorsal spine remains the site of preference while T11 recorded the highest incidence (73.3%). The vertebral body was destroyed in all the cases and the fragmentary type of bone destruction was the common observation. The incidence of cord compression demonstrated by CT was high (73.3%). Other findings were paraspinal and epidural masses observed in (66.7%) and (73.3%) respectively. CONCLUSION: CT images demonstrated the spinal level of destruction. Improved resolution also showed detailed changes within the outlined soft tissue masses, facilitating early diagnosis and prompt initiation of therapy.

Computed tomography (CT) in civilian gunshot head injuries in Ibadan.

BACKGROUND: There is data on civilian gunshot injuries in Nigerians. The purpose of the study is to describe the Computed Tomography findings of civilian gunshot injuries (GSI) to the head in Ibadan, Nigeria. METHOD: This is a retrospective study of Computed Tomography (CT) films and clinical records of 28 consecutive civilian gunshot injuries to the head from 1996 to 1999. RESULTS: The gunshot injuries to the head were mostly armed robbery related. Though there was a steady annual increase of civilian gunshot injuries during the study period, a low CT Scan frequency (0.61%) was recorded. The following CT findings were present in all the patients; bullet fragments, intraparenchymal haemorrhage, vault fractures and soft tissue swelling. The resting position of the bullets showed a predilection for the parietal lobe (32.1%) and the most common fracture site was also the parietal bone (42.8%). CONCLUSION: CT findings simplified the management of civilian gunshot injuries to the head in the patients studied by demonstrating the exact pathology sequel to the injury. Despite important constraints, CT remains a cost effective means of managing GSI to the head.

Computed tomographic patterns of intracranial infarcts in Ghanaians.

Computed tomography has given a boost to intracranial imaging in general, and the diagnosis of the subtypes of Cerebrovascular Accident (CVA) in particular. In this study of 1,172 cases of CVA examined by Computed Tomography (CT), 552 (47.10%) showed features of cerebral infarction. There was a male prevalence in the study and the mean age was 59.8 years. As in all infarcts the diagnostic appearance was a wedge shaped hypodensity within the brain parenchyma. This was most often found in the parietal lobe (73.6%) and was always without a mass effect. Even though solitary infarcts were frequent, multiple lesions were reported in 9.3% of cases and these group of respondents presented mostly with seizures. Diabetes mellitus was an important predisposing factor and was found in 163% of cases, while hypertension was found in only 9.1% of cases studied. Other CT findings were cerebral and cerebrellar atrophy. Calcification of the falx and the basal ganglia were also noted.