Relationship between placenta location and adverse pregnancy outcomes in a nigerian tertiary health facility.

Background: There is evidence that placenta site location might be associated with some adverse maternal and fetal outcomes, however, there is lack of information on this observation in Nigeria and many other developing countries where routine ultrasound is performed as part of antenatal care. Aim: To determine the relationship between placenta location on ultrasonography and adverse pregnancy outcomes among a cohort of women with singleton pregnancies. Materials and Methods: In a longitudinal study among pregnant women from the antenatal clinic of a tertiary health institution in Nigeria. The demographic, clinical parameters, the ultrasonographic placenta location, and pregnancy outcomes of women followed until delivery, or pregnancy termination were documented and analyzed; P > 0.05 was statistically significant. Result: One hundred and fifty singleton pregnant women (43 high risk and 107 normal gestations) were studied. The placenta location was anterior in 72 (48%), posterior in 59 (39.3%), fundal in 10 (6.7%) and lateral in 9 (6.0%) cases. Pregnancies with fundal placenta 8/10 (80%) had more preterm birth compared to 23/72 (31.9%), 11/59 (18.6%) and 2/9 (22.2%) that had anterior, posterior and lateral placenta (P = 0.001) respectively. The mean gestational age (GA) at delivery in those with fundal (34.0 ± 3.9 weeks), anterior (37.0 ± 2.7 weeks), lateral (37.7 ± 1.8 weeks), and posterior placenta (37.7 ± 1.8 weeks) was significantly different P < 0.001. In addition, there was a significant difference in the mean birth weight at delivery in women with fundal (2.09 ± 0.99 kg), anterior (2.84 ± 0.7 kg), posterior (3.0 ± 0.65 kg) and lateral placenta (3.0 ± 0.65 kg) respectively P = 0.002. Conclusion: This study showed that placenta location by ultrasound may be associated with some adverse pregnancy outcomes. The placenta located in the fundus was more likely to be associated with preterm birth and prematurity.

A RARE CASE OF PREPERITONEAL ABSCESS IN A NIGERIAN FEMALE: ULTRASOUND DIAGNOSIS AND PERCUTANEOUS CATHETER DRAINAGE.

A preperitoneal abscess is an uncommon manifestation of extraperitoneal collection. We present a case of an anterior abdominal wall preperitoneal abscess in a 30-year-old Nigerian female with abdominal pain and purulent abdominal wall discharge ten days after an initial admission for spontaneous bacterial peritonitis. This report underscores the role of ultrasound in diagnosis and follow-up and percutaneous ultrasound-guided continuous percutaneous catheter drainage and management of an extraperitoneal abscess.

Ultrasound evaluation of intima-media thickness of carotid arteries in adults with primary hypertension at Ibadan, Nigeria.

BACKGROUND: Ultrasound measured Carotid Intima-Media Thickness (CIMT) is a simple and inexpensive tool for assessing the cumulative effects of hypertension on the carotid arterial walls. It is also an independent predictor of future myocardial infarction and stroke risk. OBJECTIVES: This study compared ultrasound measured CIMT in hypertensive adults with non-smoking normotensive controls. It also documented variations in CIMT with subjects' age and sex. METHODOLOGY: Hypertensives (120) of both sexes aged 18 years and above were recruited from the Hypertension Clinic at University College Hospital (UCH) Ibadan. Normotensive controls (120) were also recruited from the general public. The CIMT was measured on B- mode ultrasound using the technique of 'Multiple Carotid Sites Measurement' RESULTS: Mean CIMT values were 0.756 mm ± 0.130 and 0.751 mm ± 0.129 for the hypertensive group and 0.638 mm ± 0.088 and 0.67 0mm ± 0.107 for the control group on the left and right sides respectively (P=0.000). Higher CIMT values were noted among male hypertensive subjects (P=0.030). CIMT values also showed positive correlation with subjects' age. CONCLUSION: There was a significant difference in CIMT for hypertensives when compared with normotensives in the study area. CIMT also varies with subjects' age and sex.

Ultrasound prevalence and characteristics of incidental thyroid lesions in Nigerian adults.

AIM/OBJECTIVE: Thyroid lesions are common and range from the incidental, asymptomatic, small solitary nodule to the large and partly intrathoracic masses. Thyroid lesions that are not palpable but identified by radiological imaging for unrelated symptoms are defined as incidentalomas of the thyroid gland. OBJECTIVE: The aim of this study was to determine the ultrasound prevalence of thyroid incidentalomas and describe the ultrasound characteristics of such detected incidentalomas in Nigerian adults. METHODS: This was a prospective study that examined 340 subjects over a period of 6 months. They were selected randomly from volunteers and patients presenting for ultrasound examination of other parts of the body. The subjects had their necks examined by palpation and ultrasound in the department of Radiology, University College Hospital, Ibadan, using a General Electric LogicP5 ultrasound machine with a 6-10 MHz linear transducer. Any incidentaloma detected was classified using the 'Thyroid Imaging Reporting and Data System' (TIRADS) classification. RESULTS: Three hundred and forty (340) subjects comprising of 153 males and 187 females were examined. The ultrasound prevalence of thyroid incidentalomas was 22.4%. Thyroid incidentalomas were more common in females than males but this was not statistically significant. The prevalence of thyroid incidentaloma significantly increased with age up to the seventh decade. Majority of the lesions were solitary, homogenous and cystic. CONCLUSION: The ultrasound prevalence of thyroid incidentalomas documented in the study area is high (22.4%) and they were commoner in women and older subjects. Majority of the lesions, 41 (53.95%) were classified as TIRADS 2 (benign lesions).

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.

Mediastinal bronchogenic cyst with back pain.

We report a case of a mediastinal bronchogenic cyst with back pain. The rarity of this lesion and even the more uncommon association of this lesion with symptoms of back pain prompted the report of this case.

Pneumatic reduction of intussusception in children at the Komfo Anokye Hospital, Kumasi, Ghana.

OBJECTIVE: To evaluate the role of pneumatic reduction in the management of intussusception in children in the setting of a sub-Saharan African nation. DESIGN: Prospective case series. SETTING: Tertiary care teaching hospital in Kumasi, Ghana. SUBJECTS: Forty four children, aged 4 months to 13 years, 28 boys and 16 girls, were admitted with a clinical diagnosis of intussusception and confirmed by ultrasonography. INTERVENTIONS: Twenty two children had air enema reduction of the intussusception attempted in the operation theatre under general anaesthesia. The average pressure used for air enema reduction of the intussusceptions was 110.4 mm Hg. MAIN OUTCOME MEASURES: Success of pneumatic reduction, morbidity and mortality. RESULTS: Overall air enema reduction of intussusception was successful in 59.1% of children who underwent this procedure. There were no deaths among children who had a successful air enema reduction of intussusception. One child (11.1%) out of nine who had laparotomy done after a failed pneumatic reduction died. The average length of hospital stay was shorter in those with successful air enema reduction (3.8 +/- 2.3 days, 95% Confidence Interval [CI] = 2.4 to 5.2) than those who had a laparotomy performed for manual reduction of the intussusception after a failed pneumatic reduction (6.7 +/- 5.1 days, 95% CI = 33 to 9.9). CONCLUSION: Although the sample size is small, pneumatic reduction of intussusception in children without peritonitis is possible, practical, and reliable and must be tried first, preferably under general anaesthesia in our sub-region before proceeding to laparotomy in case of failure.

Myelographic abnormalities of spinal cord and nerve roots lesions in conventional myelography.

The authors review the myelographic abnormalities of spinal lesions on 90 patients evaluated with conventional or fluoroscopy myelography between 1989 and 1995. The value of Conventional myelography in spinal lesions involving the spinal cord and nerve roots are assessed. The subjects include 49 (45.4%) males and 41 (45.6%) females with a mean age of 38.3 years. Majority of the cases 74(82.2%) had specific neurological symptoms while 16 (17.8%) presented with non-specific neurological symptoms. On the whole 78 (86.7%) cases were successfully analysed, in which 58 (74%) cases had abnormal myelograms and 20 (25.5%) had normal myelograms. Extradural lesions was seen in 47 (81%) cases, while 6 (10.3%) cases and 2 (3.5%) cases showed Intramedullary and Intradural-extramedullary lesions respectively. 3 (5.2%) cases showed combined lesions. The most common anatomical site or location of abnormal myelograms was the Thoracic region with 31 (53.4%) cases, 16 (27.6%) cases in the lumbar, 10 (17.2%)and 1 (1.8%) cases in the cervical and sacral regions respectively. Conventional myelography can be successfully used to demonstrate myelographic abnormalities, including identification and determination of the extent of the anatomical location of spinal lesions.

Hunter syndrome: case report and review of literature.

Hunter syndrome is one of the mucopolysaccharidosis, which are a rare group of genetic diseases. It is due to a deficiency in the enzyme Iduronate 2-sulphatase. This in turn leads to the accumulation of glycosaminoglycans, dermatan and heparan sulphate. The intra and extracellular accumulation of this substances lead to multisystemic organ abnormality. We present a patient with Hunter syndrome who presented with involvement of the skin, cardiovascular system, the eyes and musculoskeletal system. We have also included a literature review. As far as we know, it is the first case reported in a Nigerian.

Expression of adult polycystic renal disease in a 17-year-old male.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is found mostly in the middle-aged group. We report a rare occurrence of ADPKD in a 17-year-old male student with clinical presentation of bilateral loin pains and total haematuria. Clinical diagnosis of Acute-on-Chronic Glomerulonephritis was made. However Ultrasound and Intravenous Urography confirmed the diagnosis of Adult Polycystic Disease. The possible embryogenesis and associated anomalies of ADPKD and the radiological findings were reviewed.

Assessment of diaphragmatic levels on plain chest radiograph--a new approach.

BACKGROUND: The aim of this study was to provide an alternate simple linear measurement of diaphragmatic levels from a relatively fixed position, the lung apex, on chest radiographs. STUDY DESIGN: 526 consecutive posteroanterior (PA) chest radiographs of Nigerian adult subjects reported as normal were evaluated. The 'Lung apex to diaphragmatic apex' (LATDA) distances in centimeters for both hemidiaphragms were obtained from the chest radiographs. RESULTS: There were 210 males and 316 females ranging in age from 15 to 85 years. The mean ranges of LATDA values on the right were 21.2 cm to 23.8 cm and 20.8 cm to 22.7 cm, with total means of 22.9 cm and 21.5 cm in males and females respectively. On the left, the ranges were 23.1cm to 25.5 cm and 21.6 cm to 23.5 cm with total means of 24.4 cm and 22.6 cm in males and females respectively. Left LATDA was higher in 95% of subjects and higher LATDA values represent lower hemidiaphragms while low LATDA values indicate elevated hemidiaphragms. LATDA measurements were statistically higher in males for all age groups. Mean differences between right and left LATDA were 1.5 cm and 1.2 cm in males and females respectively. CONCLUSION: From this study, the lower limits of normal LATDA values in females and males are 16 cm and 18 cm while upper limits are 28 cm and 30 cm respectively. A "rule of twos" that could be applied to routine use in clinical practice is suggested thus: Left LATDA value is 2 cm higher than right LATDA value and LATDA values in males are 2 cm higher than in females.

Intradural spinal arteriovenous malformation of the glomus type: a case report.

Spinal arteriovenous malformations (AVMs) being even rarer than cranial ones, constitute 3 - 4% of all spinal tumours, with an overall male:female ratio of 4:1. We report the case of a 24-year old female Youth Corps member who presented with an apoplectic onset of a left hemiparesis, progressively deteriorating to an incomplete quadriplegia with motor power of 2 and 0 in the right and left lower limb muscle groups, respectively. Magnetic resonance imaging (MRI) showed a vascular malformation whose precise nature was indeterminate; the definitive diagnosis of a Glomus AVM was only made intra-operatively. Laminectomy with complete surgical excision was done and she gradually improved to ambulate with minimal support. The experience in our unit tends to support the observation in literature that spinal arteriovenous malformations could be very rare, and depending on the location, could be amenable to complete surgical excision and recovery of neurological function.

Ultrasonographic assessment of fetal gender.

The purpose of this study is to evaluate the value and accuracy of ultrasonography in the detection and determination of the gender of the fetus. This prospective study involves the Ultrasound examination of a total of 415 fetuses including 216 (52%) females and 199 (48%) males. The mean gestational age at which the fetuses were scanned was 32 weeks 1 day, with a range of 15 to 40 weeks. Fetal sex identification was only possible in 363 (87.5%) cases. Of these, the fetal sex corroborated birth sex in 314 (75.7%) and disagrees in 49(11.8%) cases. The overall estimated sensitivity of the scan in fetal sex determination is 86.5%, while the estimated specificity for identification of the female sex (90.6%) was higher than that of the male (83.2%). Despite the high efficacy of ultrasound in sex determination obtained in our study, the errors and failure rates should be made known to mothers who are willing to know the gender of their fetuses.

Computerised tomography of intracranial subdural haematoma in Ibadan.

The high mortality and morbidity associated with intra-cranial subdural hematoma (SDH), has declined significantly with the introduction of Computerised Tomography (CT) for the evaluation of the brain in suspected cases. One hundred patients with CT-diagnosed SDH at the Radiology department of the University College Hospital, Ibadan between January 1999 and December 2000 were reviewed. The mean age was 47.4 years. The most frequent cause of SDH was head injury 61 (61%). The observed CT appearances of SDH included 66 (66%) of chronic (hypodense), 30 (30%) of acute (hyperdense) and 4 (4%) of acute-en-chronic (mixed density) lesions. There were more unilateral 83 (83%) lesions than bilateral 17 (17%). The lesions were right-sided in 45 (45%) cases and left-sided in 38 (38%). A total of 169 lesions were detected as some patients had multiple sites, however, the parietal 78 (46.2%) and frontal 64 (37.9%) lobes were mostly affected. We conclude that brain CT scan offers the advantage of prompt determination and precise anatomical localization of SDH, which significantly aids management.

Incidence of dementia and Alzheimer disease in 2 communities: Yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana.

CONTEXT: Alzheimer disease (AD) represents a major and increasing public health problem. If populations were identified with significantly lower or higher incidence rates of AD, the search for risk factors in the genesis of AD could be greatly enhanced. OBJECTIVE: To compare incidence rates of dementia and AD in 2 diverse, elderly community-dwelling populations. DESIGN: The Indianapolis-Ibadan Dementia Project, a longitudinal, prospective population-based study consisting of a baseline survey (1992-1993) and 2 subsequent follow-up waves after 2 years (1994-1995) and 5 years (1997-1998). Each wave followed a 2-stage design, with an in-home screening interview followed by a full diagnostic workup of a subsample of participants based on screening performance. SETTING AND PARTICIPANTS: A total of 2459 community-dwelling Yoruba residents of Ibadan, Nigeria, without dementia, and 2147 community-dwelling African American residents of Indianapolis, Ind, without dementia (all aged 65 years or older). The cohorts were followed up for a mean of 5.1 years and 4.7 years, respectively. MAIN OUTCOME MEASURES: Incident cases of dementia and AD in each of the 2 populations. RESULTS: The age-standardized annual incidence rates were significantly lower among Yoruba than among African Americans for dementia (Yoruba, 1.35% [95% confidence interval [CI], 1.13%-1.56%]; African Americans, 3.24% [95% CI, 2.11%-4.38%]) and for AD (Yoruba, 1.15% [95% CI, 0.96%-1.35%]; African Americans, 2.52% [95% CI, 1.40%-3.64%]). CONCLUSION: This is the first report of incidence rate differences for dementia and AD in studies of 2 populations from nonindustrialized and industrialized countries using identical methods and the same group of investigators in both sites. Further explorations of these population differences may identify potentially modifiable environmental or genetic factors to account for site differences in dementia and AD.

Computerized tomography measures of brain slice area and ventricular sizes in protein energy malnutrition: a preliminary study.

The brain tissues of thirty-eight Nigerian children suffering from severe protein energy malnutrition (PEM) were evaluated within 24 hours of admission by computerized tomography. The brain slice area (B.S.A.) in marasmus (10474 +/- 1270) is significantly smaller than those of marasmic-kwashiokor (10940 +/- 1284) and kwashiokor (11866 +/- 669). Similarly also the BSA of the three clinical types were smaller than those of the control (13134 +/- 1199), (P < 001). There was poor correlation of brain slice area and other parameters measured with age, but a significantly higher (mean) brain slice area was noticed in the males (11910.82) than the females (10971.67) P < 0001, in both patients and control. Marasmic-Kwashiokor showed marked feature of cerebral shrinkage compared with the other categories of PEM in all the parameters measured.

The computed axial tomography of the brain in protein energy malnutrition.

Forty consecutive new cases of protein energy malnutrition were evaluated clinically and biochemically; in addition, the brain morphology was assessed by computed tomography within 24 hours of admission. Cerebral shrinkage was shown in six of 14 (42.9%) cases of marasmus, ten of 14 (71.4%) cases of kwashiorkor, and 11 of 12 (91.7%) cases of marasmic-kwashiorkor. Ventricular dilatation was demonstrated in 57.1% of marasmus cases, 71.4% of kwashiorkor cases and 91.7% of patients suffering from marasmic-kwashiorkor. However, none of the subjects studied showed any changes in the brain stem or cerebellum. Only ten returned 2 months after nutritional rehabilitation for repeat tomograms. None of these repeat tomograms showed any residual morphological changes. The study demonstrated that the brain is affected in all types of malnutrition, albeit in different proportions, but these changes are completely reversible.

The correlates of cortical sulci atrophy and central atrophy in a cohort of schizophrenia and manic subjects in Nigeria.

The prevalence of brain cortical sulci atrophy and central (subcortical) atrophy among Nigerian psychiatric patients is highlighted and compared with findings from developed countries. The relationship between these indices of brain atrophy and clinical parameters is also examined. Visual ratings of cortical sulci atrophy and central (subcortical) atrophy, assessed on the computed tomography (CT) image console, were compared among 50 patients with schizophrenia, 14 patients with mania and 41 healthy control subjects. The patients with schizophrenia and the patients with mania had a significantly higher prevalence of brain atrophy than normal subjects. Among the patients with schizophrenia, indices of brain atrophy were not significantly associated with disease outcome, and the presence of negative symptoms. In view of the findings from a parallel study of the same patients that psychiatric patient groups showed other evidence of CT abnormalities, the findings of this study indicate that the so-called functional psychiatric states in developing countries--as in developed countries--are probably associated with some diffuse neuropathological process.

Schizophrenic and manic brains in Nigerians. Computerised tomography findings.

BACKGROUND: We highlight the profile of brain computerised tomography (CT) measures among Nigerian psychiatric patients for comparison with findings from developed countries, and study of the relationship between CT values and clinical variables. METHOD: Seven brain ventricle measures of 50 schizophrenic patients, 14 manic patients, and 41 healthy control subjects were compared. RESULTS: Patients had a significantly higher mean Sylvian fissure area. The third ventricle of schizophrenic patients was significantly larger than those of control subjects. CT measures were not significantly correlated with duration of illness. CONCLUSION: The so-called functional psychotic states are most probably associated with non-specific brain abnormality.