Autosplenectomy of sickle cell disease in zaria, Nigeria: an ultrasonographic assessment.

OBJECTIVES: During infancy and early childhood, the spleen commonly enlarges in patients with sickle cell anemia (SCA), and it thereafter undergoes progressive atrophy due to repeated episodes of vaso-occlusion and infarction, leading to autosplenectomy in adult life. However, this may not always be the case as some studies have reported splenomegaly persisting into adult life. This study aims to determine and review the prevalence of autosplenectomy by abdominal ultrasonography in sickle cell anemic patients in Zaria, Nigeria. METHODS: An ex-post-facto cross study of 74 subjects was carried out between May to July in 2010. Hematological parameters were determined by an analyzer while B mode Ultrasonography was used to determine the craniocaudal length of the spleen, if visualized. RESULTS: The mean age of the sickle cell subjects was 23.2 ±5.3 years, while that of the controls was 22.7±12.4 years. Of the 74 sickle cell subjects, 55.4% were females; while of the 20 controls, 50% were females. Forty one subjects (55.4%) had autosplenectomy and a significant difference existed in the mean splenic size compared with the control (p<0.0001). Only 3 (4.05%) subjects had splenomegaly, while 23 (31%) had a shrunken spleen. CONCLUSION: Anatomical autosplenectomy is not an uncommon finding in SCA patients. This may be related to inadequate clinical care due to the lack of good health education, ignorance, poverty, and poor standard of care, as well as the lack of newer therapeutic agents.

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.

Computerized tomography of children with seizure disorders.

BACKGROUND: Neuro-imaging is generally considered as part of the evaluation of seizures and epilepsy. There is limited information about its usefulness in our environment. We describe the pattern of CT findings in children with seizures in our environment. METHOD: We carried out a retrospective review of the computerized tomography findings in children with recurrent seizures over a one year period, November 2005 to October 2006. RESULTS: During the study period, 49 infants and children had computerized tomography performed on them out of which 19 had CT done for recurrent seizures. They ranged in age from 4 months to 16 years with 13 of them being boys. Generalized tonic--clonic seizures was the most predominant seizure type, being present in 10 of the 19 (52.6%) children while simple partial seizure, myoclonic jerk and mixed seizure types were present in 2 cases each. Abnormal scan was demonstrated in 10 of the 19 children (52.6%) with 3 of them having double cerebral lesions, giving a total of 13 cerebral lesion demonstrated by the CT scan. Cerebral infarct was the most common lesion demonstrated, being present in 5 of the 13 lesions (38.5%). Others were cerebral atrophy in 4 cases (30.8%), moderate ventricular dilatation 2 (15.4%) and 1 each ofporencephalic cyst, hydrocephalus and linear skull fracture. Of the 10 children with abnormal scan, 90% of them had significant past medical history, with birth asphyxia (44.4%) and meningitis (33.3%) being the commonest significant past medical history in them. CCONCLUSION There is a high incidence of abnormal scan findings in children with seizure disorder in our environment compared to what is obtained from the developed countries. Cerebral infarct appears to be the most common abnormal CT findings in our children with seizures.

Congenital vaginal fistula from a single system ectopic ureter: A case report.

BACKGROUND: Vaginal fistulae particularly vesico-vagina fistula, is a common urogynaecologic problem in Sub-Saharan Africa. Majority of these cases are acquired and congenital fistulas are rare. We here report a case of congenital vaginal fistula secondary to an ectopic ureter in 15 year old Nigerian female. METHOD: The case records of a 15 year old female who presented to the obstetrics and gynaecological unit of the Federal Medical centre Azare and a Review of literature on the subject was used. RESULT: A 15-old-girl presented with continuous leakage of urine from the vaginal since birth despite the establishment of normal voiding habit. Examination revealed urine leaking from a pinhole fistula in the vestibule. Intravenous urography showed delayed excretion of the right kidney with a normal single ureter (single system) and normal left kidney. Ureteric implantation into the bladder was performed with good postoperative outcome. CONCLUSION: In an environment with scarce resources, managing ectopic ureter in the female is quiet challenging. Multidisciplinary approach involving the urologist, paediatric surgeon, radiologist and the gynaecologist will yield the best outcome.