EFFECTIVE DOSE AND RISK ESTIMATES IN ADULT PATIENTS FROM FOUR RADIOLOGICAL PROCEDURES EXTRAPOLATED OVER TWO POPULATIONS AT SOME SELECTED CENTERS IN LAGOS STATE, NIGERIA.

In this study, risk of exposure to adult patients in some common radiological procedures was estimated at selected diagnostic centers in Lagos State, Nigeria using estimated average effective doses. The results showed that pelvis lateral (LAT) examination with the lowest estimated mean effective dose level (2.61) recorded the highest probability of cancer incidence and mortality occurrences, while lumbar anteroposterior (AP) had the lowest (3.61). A high sum total of probability of fatal cancers and the total weighted probability of non-fatal cancer in a single exposure to low-dose ionizing radiation were recorded in pelvic procedure among others. Also, a high-percentage mortality increase of solid cancers was recorded in chest PA examination (53.7%), while the lowest was in lumbar spine radiography (with lumbar AP = 0.14%, lumbar LAT = 0.15%). The data obtained suggested the possibility of having higher percentage mortality and cancer-related incidence in the chest.

Nonalcoholic fatty liver disease: Synopsis of current developments.

Non-alcoholic fatty liver disease (NAFLD) which is defined as the accumulation of fat>5% of liver weight is increasingly becoming an important cause of chronic liver disease. This article tries to chronicle advances that have occurred in the understanding of the pathogenesis, pathology as well as the management of this disease. We have done a Medline search on published work on the subject and reviewed major conference proceedings in the preceding years. The Pathogenesis involves a multi-hit process in which increased accumulation of triglycerides in face of insulin resistance results in increased susceptibility to inflammatory damage mediated by increased expression of inflammatory cytokines and adipokines, oxidative stress and mitochondrial dysfunction, endoplasmic reticulum stress and gut derived endotoxemia. An interplay of multiple metabolic genetic expression and environmental factors however determine which patient with NAFLD will progress from simple steatosis to non-alcoholic steatohepatitis (NASH) and liver cirrhosis. The minimum criteria for diagnosis of NASH are steatosis, ballooning and lobular inflammation; fibrosis is not required. The NASH Clinical Research Network (CRN), histological scoring system is used to grade and stage the disease for standardization. The management of NAFLD consists of treating liver disease as well as associated metabolic co-morbidities such as obesity, hyperlipidaemia, insulin resistance and type 2 diabetes mellitus (T2DM). Patient education is important as their insight and commitment is pivotal, and lifestyle modification is the first line of treatment. Improvement in liver histology in non-diabetic NASH patients has been reported with use of Vitamin E. Other liver-related therapies under investigations include pentoxyfiylins, Caspar inhibitors, Resveratrol as well as probiotics. The prognosis (both overall and liver-related mortality) for simple steatosis is not different from that of the general population however.

Dimensions, septation, and pattern of pneumatization of the sphenoidal sinus.

The endoscopic endonasal transsphenoidal approach (EEA) to treat sellar, parasellar, and suprasellar tumours continues to gain increased significance. Due to the close proximity of the sphenoid sinus to the carotid artery and the optic canal, it is very important for surgeons to know the anatomical features and variations of the sphenoid sinus as relevant to EEA. A prospective study of the sphenoid sinus morphology was carried out on the cranial tomographic (CT) scan images of 60 Nigerian adult patients. The CTs were reviewed regarding the different anatomical variations of the sphenoid sinus: dimensions, septation, and pattern of pneumatisation. There were 37 males and 23 females. The patients' ages ranged from 18 years to 85 years, with a mean of 47.2 years. There was a main single intersphenoid septum in most patients (95%). The insertion of the septum was usually to the right posteriorly (38%) and in the midline anterior (65%). Although there is usually a main septum, the septa present were multiple in 29 of the sinuses studied. There was no gender difference with respect to the attachment of the main sphenoid sinus septum. The sphenoid anterior, posterior, and transverse dimensions were not significantly dependent on age, but they were longer in males than in females. Sellar pneumatization was present in the majority of the patients (83%), with 4 patients having postsellar pneumatization (6.7%) and 3 patients having presellar pneumatization (5%). There were no cases with conchal pneumatization or lateral pneumatization of the greater wing of the sphenoid. The present study provides anatomical information about the sphenoid sinus dimensions morphology that is essential for avoiding complications in performing an endoscopic sphenoidotomy.

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 Mohan's valvotome for the ablation of PUV. MATERIALS AND METHODS: All patients with PUV who underwent Mohan's 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 Mohan's valvotomy. CONCLUSION: Mohan's valvotome is an effective instrument for the ablation of PUV. It is invaluable in the developing world where paediatric endoscopes are not readily available.

Retrograde pericatheter urethrogram for the post-operative evaluation of the urethra.

Pericatheter urethrogram (PUG) has been found to be a useful assessment tool after endoscopic urethral realignment or open urethroplasty prior to removal of the urethral catheter. Very little is known in the English literatures of the procedure of PUG in the evaluation of the urethra post-operatively. We aim to describe our technique of PUG and its usefulness in the evaluation of the urethra. We reviewed 22 patients who underwent PUG after endoscopic urethral realignment or urethroplasty over an 18 month period in our institution. The indications, procedure and success of PUG were noted. The radiological findings were also documented. The mean age of the patient was 31.9 years. Seventeen (77.3%) and 5 (22.7%) patients had PUG at least 3 weeks after endoscopic realignment of the urethra and urethroplasty for urethral strictures respectively. PUG was successful in all the patients and no complication arising from the procedure was recorded. The radiographs showed satisfactory urethral healing in 15 (68.2%), urethral stenosis in 2 (9.1%), contrast media extravasations in 8 (36.4%). We concluded that PUG allows for adequate urethral assessment and healing before the indwelling catheter is removed.

Clinical and radiological characteristics of Nigerian boys with posterior urethral valves.

Posterior urethral valve (PUV) obstruction is the most common cause of bladder outlet obstruction in boys. Currently, the diagnosis of PUV is commonly made prenatally. In our environment, however, prenatal diagnosis is rare and the diagnosis is usually made postnatally from the clinical and radiological features. This study therefore examines the clinical and radiological spectrum of boys with PUV in our environment. We examined the clinical presentations, ultrasonographic and the micturating cystourethrographic (MCUG) features of boys with PUV in our institution over a 22-month period from June 2006. There were 28 patients with PUV over this period. The age at presentation ranged from 11 days to 11 years (mean age = 2.7 years). Although prenatal ultrasound scan was done in 23 (82.1%) patients, no prenatal diagnosis was made in any of the patients. The diagnosis was made after infancy in 16 (57.1%) patients. Recurrent urinary tract infection (UTI) was the most common mode of presentation occurring in 14 (50.0%) patients with 7 (50.0%) of the patients with UTI presenting with septicaemia. Voiding dysfunctions, which occurred in all the patients, were the primary mode of presentation in 12 (42.9%) patients. Three (10.7%) patients presented with renal insufficiency, which was significantly associated with the age at presentation (P = 0.026). Ultrasound scan done in the postnatal period strongly suggested the diagnosis of posterior urethral valves in 22 (78.6%) patients in whom the posterior urethra was found to be dilated, associated with thick-walled urinary bladder and bilateral hydronephrosis. Trabeculations of the bladder was a constant feature on MCUG. Other features on MCUG included dilatation of the posterior urethra in 26 (92.8%), bladder diverticuli in 15 (53.6%) and unilateral and bilateral vesicoureteric reflux in 3 (10.7%) and 1 (3.6%) patient(s), respectively. The diagnosis of PUV obstruction which is often made late in our environment, is mainly by clinical, sonographic and MCUG features in the postnatal period. A majority of patients present late, with recurrent UTI.