The pattern of chest radiographs findings in metastatic cancer patients seen in a tertiary hospital in northern Nigeria.

AIMS AND OBJECTIVES: To evaluate the pattern of chest radiographs findings in metastatic cancer patients at first presentation in a tertiary hospital in northern Nigeria with a view to contributing to existing literature and making recommendation for optimal patients care in Nigerian hospitals. PATIENTS AND METHODS: From January 2002 to December 2007, 712 new patients were seen and 688 patients' chest radiographs excluding children (below 16 yr) were reviewed of which 118 were considered abnormal due to pathology arising from primary cancer. Those Chest radiographs showing pathology not related to cancer were excluded. Results were analysed using EPI-Info, version 3.4.1. 2007. RESULTS: 118 (17%) patients' chest radiographs (CXR) were having evidence of metastases from primary cancer. The sex ratio is M: F = 1: 1.7 with a mean age of 48.1 years (Range 16 - 82 yrs). Breast cancer was the commonest cause of metastatic spread to the lungs seen in 44 (37.3%) patients followed by colorectal 10 (8.5%), soft tissue sarcoma 9 (7.6%), and bone sarcoma 8 (6.8%). Cervical cancer which was the commonest type of malignancies seen at presentation accounted only for 8 (6.7%) cases. Both lungs were involved in 62 (52.5%) patients, followed by right lung alone in 42 (35.6%) cases and left lung alone in 14 (11.9%) cases. The mid zone was the commonest site of lung metastases 102 (86.4%) followed by lower zone 42 (35.6%). Pleural effusion seen in 26 (22%) patients affected both lungs equally. Multiple lung metastases were the predominant pattern of metastases seen in 94 (80%) cases. Majority 82 (69.5%) of lungs metastases were of sizes less than 2cm. CONCLUSION: Multiple lung metastases were the commonest pattern of lung metastases. Both lungs and mid zone were mainly affected. Lung metastases were very common from breast, colorectal, bone sarcoma, prostate cancers but relatively rare from cervical, head and Neck cancers and lymphomas. Chest radiographs should be part of initial evaluation of all cancer patients.

Adult learning principles for effective teaching in radiology programmes: a review of the literature.

BACKGROUND: Adult learning processes of acquisition of new knowledge, behaviours, skills, values or preferences generally occur as part of personal professional development. There is need for radiology residency trainers to understand the basic adult learning principles for effective teaching processes. OBJECTIVE: To review the different adult learning styles, learning theories and educational practice as a guide for radiology residency trainers. METHODS: Literature materials from journals, web articles and reputable textbooks in the last 20 years on adult learning principles in general and radiology in particular were reviewed. RESULTS: Most medical educators, including radiologists, lack appropriate formal training background in educational practice. The adult residency trainee brings to the learning environment high quantity and quality of experiences and some amount of control. Connection of this rich adult experience base to the learning process requires facilitation and motivation by the radiology educator, who must be familiar with the use of appropriate learning theories and educational practices. CONCLUSION: there is a general agreement about the content of good practice in adult education but a definite comprehensive list does not seem to exist in the literature. Nonetheless, understanding of the basic adult learning principles would aid the concept of guided training, where the adult residency trainee shoulders the bulk of the training responsibilities of acquisition of knowledge.

Malpractice and medicolegal issues in radiology practice: knowledge base for residency trainees and trainers.

BACKGROUND: Medical malpractice is a global problem of professional negligence resulting in damage or harm to a patient due to deviation from accepted standards of practice. Radiology service delivery to patients from all the four major medical disciplines and the ever increasing imaging arsenal potentially increase the incidence of adverse events in radiology. It is pertinent therefore, that radiology practitioners become conversant with the regulatory role of the medical malpractice system in the protection of the right of patients. AIMS AND OBJECTIVES: To document the knowledge base of medical malpractice in current literature in order to arouse the awareness of radiology residency trainees and trainers to this all-important professional practising issue. MATERIALS AND METHODS: Literature materials on medical malpractice in general and Radiology in particular were reviewed. Four illustrative case reports from past experiences were highlighted. Discussion was carried out on the historical perspective, classes, defendant status, legal requirements and prevention of medical malpractice. RESULTS: Discovery of x-ray in 1895 shifted focus of medical malpractice matters to Radiology. Practically all imaging techniques, including US, CT, MRI have been subject of malpractice lawsuits. Cognitive and perceptual diagnostic errors constitute 70% of malpractice cases against radiologists. CONCLUSION: Adequate professional training, informed consent by the patient and improved doctor-patient relationship are basic to standard medical practice.

Brain tumour as a predisposing factor to head trauma: a review of two cases diagnosed by computed tomography.

BACKGROUND: Brain tumours and head trauma are two pathological entities that may involve the central nervous system to produce similar clinical neurologic signs and symptoms. There has been a long-term debate in the literature on association between these two clinical conditions following observations over time of development of intracranial tumours in individuals who previously sustained head injury. In this teaching centre, there were in succession, two cases of head injury which, at brain CT scanning, turned out to be brain tumours. These findings stimulated the need to review the literature. OBJECTIVE: To examine the literature for evidence of the role of brain tumour as a factor in development of falls and subsequent head injury and thus raise awareness of their association. METHODS: Related literature materials on brain tumours and head injury were reviewed. RESULTS: Some reports in the medical literature established only weak evidence in support of head injury as an aetiologic agent for brain tumour occurrence; others found no association between them. CT and MRI are useful investigative modalities. CONCLUSION: Head trauma may only have caused small and preexisting quiescent tumour to grow as a result of predisposition to fall by musculoskeletal incoordination caused by the tumour itself.

Achalasia of the oesophagus in infancy: a case report.

BACKGROUND: Achalasia characteristically causes dismotility of the lower oesophageal sphincter and defective peristalsis of the body of the oesophagus, in response to the act of swallowing, as a result of ganglionic cells degeneration. The resultant oesophageal dilatation leads to food stasis and may cause oesophagitis and tracheobronchial aspiration. Achalasia is a rare occurrence in the paediatric age group and even more extremely rare in the neonate and young infant. Urgent radiologic evaluation of the underlying cause of persistent on-going vomiting in an infant is mandatory. OBJECTIVE: To emphasize the role of upper gastrointestinal imaging in infants with persistent on-going vomiting, severe dehydration and malnutrition through case illustration of a 9-month-old infant seen in a private medical outfit in Lagos. METHODS: Dilute barium oesophagogram, pre- and postoperatively, was performed in a 9-month-old infant and illustrative images were presented. Literature materials on achalasia of the oesophagus were reviewed and juxtaposed with findings in the illustrated case for discussion. RESULTS: Only 3 to 4 percent of achalasia is reported to occur in the paediatric age group with average duration of 28 months from onset of symptoms to diagnosis. Persistent vomiting and failure to thrive are common. Pneumatic dilatations and surgical myotomy are recommended treatment methods. CONCLUSION: Urgent upper gastrointestinal contrast study is appropriate in infants with suspected achalasia for successful management.

The value of plain abdominal radiographs in management of abdominal emergencies in Luth.

OBJECTIVE: The plain abdominal x-ray is still the first imaging modality in diagnosis of acute abdomen. The aim of this study was to find the value of plain abdominal x-ray in the management of abdominal emergencies seen in Lagos university teaching hospital. BACKGROUND: The accurate diagnosis of the cause of acute abdominal pain is one of the most challenging undertakings in emergency medicine. This is due to overlapping of clinical presentation and non-specific findings of physical and even laboratory data of the multifarious causes. Plain abdominal radiography is one investigation that can be obtained readily and within a short period of time to help the physician arrive at a correct diagnosis The relevance of plain abdominal radiography was therefore evaluated in the management of abdominal emergencies seen in Lagos over a 12 month period (April 2002 to March 2003). METHOD: A prospective study of 100 consecutively presenting patients with acute abdominal conditions treated by the general surgical unit of Lagos University Teaching Hospital was undertaken. All patients had supine and erect abdominal x-ray before any therapeutic intervention was undertaken. The diagnostic features of the plain films were compared with final diagnosis to determine the usefulness of the plain x-ray RESULTS: There were 54 males and 46 females (M:F 1.2:1). Twenty-four percent of the patients had intestinal obstruction, 20% perforated typhoid enteritis; gunshot injuries and generalized peritonitis each occurred in 13%, blunt abdominal trauma in 12%, while 8% and 10% had acute appendicitis and perforated peptic ulcer disease respectively. Of 100 patients studied, 54% had plain abdominal radiographs that showed positive diagnostic features. Plain abdominal radiograph showed high sensitivity in patients with intestinal obstruction 100% and perforated peptic ulcer 90% but was less sensitive in patients with perforated typhoid, acute appendicitis, and blunt abdominal trauma and generalized peritonitis. CONCLUSION: In conclusion, this study shows that abdominal radiographs are useful when appropriate criteria are followed in requesting for the investigation. The investigation should be requested for all patients with moderate to severe abdominal tenderness, those with gunshot injuries, blunt abdominal trauma and generalized peritonitis. It should be an integral part of management of patients with clinical suspicion of bowel obstruction and gastrointestinal perforation.

Role of computed tomography in the management of adult brain tumours.

BACKGROUND: Neuroradiologic imaging has revolutionised the management of brain tumours through precise presurgery diagnosis and accurate definition of the extent of disease. This report attempts to evaluate our five years of clinical experience with intracranial CT scanning in the management of adult brain tumours. MATERIALS AND METHODS: The study included 160 adults with demonstrable brain tumours on CT imaging between 1997 and 2001. Surgical confirmation and histologic typings were recorded. All CT scans were carried out on Siemens Somatom AR.T scanner. A complete CT examination includes pre- and post-contrast examination done at 5 to 10 mm slice thickness and 10 mm interval from the base of skull to the vertex. All scans were viewed and documented in soft tissue and bone windows and multiplanar reconstruction appropriate for optimum visualisation of the areas of interest. All CT scans of the study population were analysed by age, sex, symptomatology, type and location of tumour. RESULTS: There were 92 males and 68 females with a mean age of 48 +/- 0.68 years. Headache accounted for 41.2% of the presenting symptoms while cerebral hemispheric tumours are more frequently (60.6% ) encountered. Gliomas are the commonest group (68.8% ). CONCLUSION: CT examination has improved the management of patients with brain tumours in our teaching hospital and will continue to remain the mainstream neuroradiologic imaging technique for a very long time.

Comparison of the accuracy of trans-abdominal sonography (TAS) and transperineal sonography (TPS) in the diagnosis of Placenta Praevia.

BACKGROUND: Although the incidence of Placenta Praevia (PP) is low, its association with increased perinatal and maternal morbidity and mortality underscores the imperative of accurate pre-labour diagnosis. OBJECTIVE: To compare through a prospective study, the accuracy, sensitivity and specificity of Trans-Abdominal Sonography (TAS) and Trans-Perineal Sonography (TPS) in the diagnosis of Placenta Praevia and to determine the causes, if any, of avoidable diagnostic errors. METHODS: During the study period from 1999 to 2001, 133 patients were evaluated by TAS and TPS. The age ranged from 19-41 years while the gestational age ranged from 20-weeks to term. All had examination with 3.5 MHz mechanical sector real-time scanner (Siemens high-resolution Sonoline SL-1 ultrasound machine). The accuracy of TAS and TPS in diagnosing PP was then compared with surgical outcome in each patient. RESULTS: Out of the 133 patients diagnosed to have PP early on in pregnancy, 41 (30.8%) had persistent praevia till delivery, while in 92 (69.2%), the placenta converted to a normal location. The diagnosis at delivery confirmed the TPS diagnosis in 40 of 41 cases, while TAS diagnosis was confirmed in 39 of 41. TPS did not predict the delivery diagnosis in 1 patient where it ruled out a PP, TAS did not predict the delivery diagnosis in 2 patients who were believed not to have a clinically significant placenta praevia. In 1 patient TAS suggested PP but delivery diagnosis showed a normal placental implantation. The overall accuracy, specificity and sensitivity for TPS and TAS were 99.3%, 100%, 99.2% and 97.7%, 98.9%, and 95.1% respectively. CONCLUSION: TPS is a safe, accurate and rapid technique, which complement TAS for evaluation of patients with PP. In patients who decline this method however, graded bladder distension, Trendelenburg and traction scanning and determination of the absence of focal uterine contraction, which distorts the lower uterine segment, are techniques, which significantly improve the diagnosis of PP by TAS.

Ultrasonographic measurements of the hepatobiliary axis of children with sickle cell anaemia in steady state

Sickle cell anaemia is associated with structural manifestations in the hepatobiliary axis but these manifestations have not been sufficiently examined in Nigerian or African children. This study wasconducted to evaluate the results of ultrasono-graphic measurements of the hepatobiliary axis of children with sickle cell anaemia in a Nigerian teaching hospital. One hundred and twenty children with Hb SS in steady state aged between 12 months and 15 years and sixty children with Hb AA matched by age and sex (as controls) were consecutively recruited from April through November 2002. Past and present medical histories were obtained and physical examination and abdominal ultrasonography were performed. The mean liver span; the common hepatic duct and common bile duct diameters; the longitudinal and transverse dimensions (but not the wall thickness) of the gallbladder were significantly higher in test subjects than controls (p 0.05). Multiple regression showed that age correlated significantly with all the studied ultrasound scan (USS) measurements (p 0.05). Recurrent episodes of abdominal pain correlated with gallbladder wall thickness (p

Melorheostosis of Leri: report of a case in a young African.

UNLABELLED: Melorheostosis of Leri is a non-familial condition of hyperostosis of the cortical bone that usually presents unilaterally in long bones of the upper and lower limbs, but may also present in vertebra, ribs, skull and jaw. The incidence of this disease is quite rare, only about 300 cases have been reported worldwide. We present a case, which may be the first documented case in sub-Saharan Africa. CLINICAL PRESENTATION: S.K. is a 14 year old male student who presented to the hospital with an 18 month history of persistent pain in the joints of the right upper limb and a limb length discrepancy since birth which has worsened with growth. Examination revealed generalised hypoplasia of the right upper limb with shortening of the limb and atrophy of the muscles, also hypoplasia and contracture of the thumb was observed. The radiographs of the limb showed multiple areas of dense hyperostosis and scleroderma, which showed a linear distribution along the radial half of the bones. CONCLUSION: In children presentation of melorheostosis, is more likely be as limb length discrepancy, deformity or joint contractures which may be seen before radiographic evidence of any bony changes. Improvement in imaging techniques will therefore result in early diagnosis and greater success with conservative management. Also the increased frequency of tumours necessitates long-term follow up. KEYWORDS: melorheostosis, scleroderma.