Changes in opthalmic artery doppler velocimetry in women with preeclampsia in Kano, Nigeria.

Background: Hypertensive disorders in pregnancy are among the most serious complications of pregnancy and represent important contributors to maternal and neonatal morbidity and mortality worldwide. Preeclampsia (PE)-eclampsia syndrome is the most important hypertensive gestational condition. Maternal ophthalmic artery Doppler velocimetry enables the identification of pregnant women with increased cerebral blood flow who are at risk of developing severe PE and eclampsia. Hence the need to determine the changes in ophthalmic artery Doppler velocimetric indices in PE in Kano,Nigeria becomes paramount. Materials and Methods: Ninety-six patients with the clinical diagnosis of PE and 96 normotensive pregnant controls between 20 and 40 weeks' gestational age were recruited for this study. Ophthalmic artery Doppler velocimetric indices of the two groups were measured and documented. Results: The mean velocimetric measurements in the control group were as follows: peak systolic velocity (PSV) = 38.04 ± 13.68 cm/s, End-diastolic volume (EDV) =9.14 ± 3.65 cm/s, resistivity index (RI) = 0.75 ± 0.091, pulsatility index (PI) =1.62 ± 0.55, peak mesodiastolic velocity (PMDV) = 21.02 ± 8.83 cm/s, peak ratio (PR) = 0.56 ± 0.14. The mean velocimetric indices in the PE group were PSV = 44.59 ± 11.54 cm/s, EDV = 12.23 ± 2.66 cm/s, RI = 0.71 ± 0.069, PI = 1.67 ± 0.42, PMDV = 32.27 ± 9.12 and PR = 0.72 ± 0.10. Conclusion: There is a significant difference in the ophthalmic artery Doppler velocimetric indices between women with PE and normal pregnant women. Ophthalmic artery Doppler ultrasound is a useful tool in monitoring the hemodynamic changes in cerebral circulation in PE.

Résumé Contexte: Les troubles hypertensifs de la grossesse font partie des complications les plus graves de la grossesse et représentent des contributeurs importants à la morbidité et à la mortalité maternelles et néonatales dans le monde. Le syndrome de pré-éclampsie-éclampsie est la condition gestationnelle hypertensive la plus importante. La vélocimétrie Doppler de l'artère ophtalmique maternelle permet d'identifier les femmes enceintes présentant un débit sanguin cérébral accru qui risquent de développer une pré-éclampsie et une éclampsie sévères. D'où la nécessité de déterminer par échographie les changements des indices vélocimétriques Doppler de l'artère ophtalmique dans la pré-éclampsie à Kano, au Nigeria. Méthodes: Quatre-vingt-seize patientes présentant un diagnostic clinique de prééclampsie et quatre-vingt-seize témoins enceintes normotendues entre 20 et 40 semaines d'âge gestationnel ont été recrutées pour cette étude. Les indices vélocimétriques Doppler de l'artère ophtalmique des deux groupes ont été mesurés et documentés. Résultats: Les mesures vélocimétriques moyennes dans le groupe témoin étaient les suivantes ; PSV (Vitesse systolique maximale) = 38,04 ± 13,68 cm / s, EDV (volume diastolique final) = 9,14 ± 3,65 cm / s, RI (indice de résistivité) = 0,75 ± 0,091, PI (indice de pulsatilité) = 1,62 ± 0,55, PMDV ( Vitesse méso diastolique maximale) = 21,02 ± 8,83 cm / s, PR (rapport maximal) = 0,56 ± 0,14. Les indices vélocimétriques moyens dans le groupe PE (PE) étaient ; PSV = 44,59 ± 11,54 cm/s, EDV = 12,23 ± 2,66 cm/s, RI = 0,71 ± 0,069, PI = 1,67 ± 0,42, PMDV = 32,27 ± 9,12 et PR = 0,72 ± 0,10. Conclusion: Il existe une différence significative dans les indices vélocimétriques Doppler de l'artère ophtalmique entre les femmes atteintes d'EP et les femmes enceintes normales. L'échographie Doppler artérielle ophtalmique est un outil utile pour surveiller les modifications hémodynamiques de la circulation cérébrale dans la prééclampsie. Mots clés : Doppler, Hypertension, Artère ophtalmique, Prééclampsie.

Limb Revascularization of Peripheral Artery Disease in the Developing Countries: Earliest 1-Year Experience from Northwestern Nigeria.

PURPOSE: The purpose of the study is to present the preliminary audit and challenges of earliest cases of balloon angioplasty from Northwestern Nigeria. MATERIALS AND METHODS: We present our first 25 cases of peripheral angioplasty in Northwestern Nigeria. The clinical diagnosis of peripheral artery disease was confirmed with Doppler ultrasound and angiography. Angioplasty was done either through femoral or brachial artery approaches. The patients were monitored for minimum of 6 months with serial clinical and Doppler ultrasound examinations. RESULTS: Our patients consist of 19 males and 6 females. Their ages ranged from 20 to 80 years with a mean of 54 ± 17.5 years. There were 13 hypertensive and 15 diabetic patients while 5 patients have co-morbidities of diabetes and Hypertension. Although femoral antegrade route is the common access for angioplasty (14 out of 25), seven patients who were treated through the left brachial artery, six of them had either Type C or D aortoiliac disease in addition to distal lesions. At follow-up, 36% had limb amputation while one patient died a day after the procedure. Out of nine patients who had amputation, six are diabetic. CONCLUSION: Although more than half of them had improved blood flow with healing ischemic ulcers and reducing claudications, still substantial number of our patients often present late with severe peripheral artery disease. As a result, we had to resort to cumbersome arterial access and high amputation rate.

Limb revascularization of peripheral artery disease in the developing countries: earliest 1-year experience from Northwestern Nigeria

Purpose: The purpose of the study is to present the preliminary audit and challenges of earliest cases of balloon angioplasty from Northwestern Nigeria. Materials and Methods: We present our first 25 cases of peripheral angioplasty in Northwestern Nigeria. The clinical diagnosis of peripheral artery disease was confirmed with Doppler ultrasound and angiography. Angioplasty was done either through femoral or brachial artery approaches. The patients were monitored for minimum of 6 months with serial clinical and Doppler ultrasound examinations. Results: Our patients consist of 19 males and 6 females. Their ages ranged from 20 to 80 years with a mean of 54 ± 17.5 years. There were 13 hypertensive and 15 diabetic patients while 5 patients have co-morbidities of diabetes and Hypertension. Although femoral antegrade route is the common access for angioplasty (14 out of 25), seven patients who were treated through the left brachial artery, six of them had either Type C or D aortoiliac disease in addition to distal lesions. At follow-up, 36% had limb amputation while one patient died a day after the procedure. Out of nine patients who had amputation, six are diabetic. Conclusion: Although more than half of them had improved blood flow with healing ischemic ulcers and reducing claudications, still substantial number of our patients often present late with severe peripheral artery disease. As a result, we had to resort to cumbersome arterial access and high amputation rate

Clinical and doppler ultrasound evaluation of peripheral arterial diseases in Kano, North-western Nigeria.

AIMS AND OBJECTIVES: Doppler ultrasound scan is a non-invasive and cheap tool that complements the roles of computed tomography, magnetic resonance imaging and catheter digital subtraction angiography in the screening, diagnosis and follow up of vascular diseases. In this study, we evaluated and described the findings of the Doppler ultrasound of the peripheral arteries performed at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. PATIENTS AND METHODS: All the findings of peripheral arterial Doppler ultrasound examinations performed at AKTH during a period of 18 months (from February 2012 to July 2013) were reviewed. All examinations were done using 7.5 MHz linear transducer connected to Mindary Digital Ultrasound Imaging System (Model DC-6; Shenzhen Mindray Biomed Electronics, Shenzhen, China). A 3.5 MHz convex transducer of the same machine was used in obese patients and those with severe subcutaneous oedema. RESULTS: The findings of 50 males and 28 females were reviewed. Their mean age was 55.8 ΁ 17.9 years. Diabetic foot disease, intermittent claudication, gangrene and limb swellings were the most common indications for arterial Doppler examination of the lower limbs, constituting 32.1%, 20.5%, 16.7% and 15.4%, respectively. Significant luminal stenosis, total luminal occlusion and loss of arterial resistance were the most frequent findings, constituting 29%, 26.9% and 7.7%, respectively. Femoro-popliteal and below the knee arteries were commonly involved by these abnormalities. Arrhythmia, increased intimal media thickness and wall calcifications were the common compounding findings while diabetes and hypertension were frequently associated clinical problems of these patients. CONCLUSION: Doppler ultrasound has a high diagnostic yield in depicting abnormalities in patients with clinical features of peripheral arterial disease.

Prenatal third trimester sonographic behavior of a thanatophoric dwarfs.

OBJECTIVES: Thanatophoric dysplasia (TD), the most common of the congenital lethal skeletal dysplasias occurs sporadically in 1/64,000-100,000 live births. To the best of our knowledge, the in utero attitudes and behaviours of such babies with serial ultrasound scans have not been previously described. We present the in utero third trimester sonographic behaviors of TD in a 22-year-old primigravida diagnosed at '32weeks' gestational age along with the clinical and radiographic characteristics. METHODS: The same radiologists to observe the behavior of a thanatophoric dwarfs did three fortnights serial ultrasound scans. RESULTS: The baby was found to have short limbs that were constantly in rigid abduction, flexed at both elbows and knees, and demonstrated poverty of synchronous movements. The upper limbs were perpetually in embracing position during all scans. In addition, he was hyperactive, showing "yoyo" body movement and constantly hyper-extended neck. Postmortem radiograph was diagnostic of TD. CONCLUSION: Though he baby died intra partum, the observed attitudes and behaviors on serial prenatal ultrasonography, which provided us with sufficient information to counsel the family, managed the pregnancy, and direct the postnatal evaluation could possibly add to the in utero diagnostic sonographic features of TD.