Variations of renal vascular anatomy in a nigerian population: A computerized tomography studys.

BACKGROUND: A broad spectrum of renal vascular variations has been reported by anatomists and radiologists. The prevalence of these variations is extremely divergent in different populations. Therefore, radiologists and surgeons in different climes must be knowledgeable about the type and prevalence of the variants in their area of practice to avoid diagnostic pitfalls and for optimization of surgical techniques. OBJECTIVE: The objective of this study is to describe the types and prevalence of renal vascular variations among patients undergoing contrast-enhanced computerized tomography (CECT) of the abdomen in a Nigerian population, as well as provide a concise review of literature on the embryological basis and clinical significance of the identified variations. MATERIALS AND METHODS: This study was a retrospective review of 200 CECT of the abdomen to identify variations of arterial (accessory, early branching, and precaval) and venous (multiple, retroaortic, and circumaortic) anatomy of the kidneys. RESULTS: We studied 200 patients, 102 (51%) females and 98 (49%) males. Age range is 18-90 years (mean = 53.08 ± 17.01). Prevalence of any renal vascular variations was 50%, arterial variations were 37%, and venous variations were 13%. Variations were significantly more common in males, P = 0.000075. The most common arterial variant was the accessory renal artery (23%) seen in 10% (right) and 13.0% (left); early branching was seen in 4.0% (right) and 0.5% (left) as well as precaval right renal artery seen in 4.5%. Venous variants were late confluence 3.0% (right) and 2.5% (left); multiple veins was seen in 2.5% (right) and 2.5% (left) as well as retroaortic left renal vein seen in 2.0%. The inferior polar accessory artery was the most prevalent accessory artery. Early arterial bifurcation was significantly more common on the right (P = 0.016) while other vascular variants showed no statistically significant association with laterality. CONCLUSION: Variation of renal vascular anatomy is a frequent finding among Nigerians. Radiologists and surgeons must be aware of these variants for optimization of surgical techniques.

Radiation dose and radiation protection principle awareness: a survey among Nigerian paediatricians.

AIMS AND OBJECTIVES: This study is aimed at determining the knowledge of Paediatricians in Nigeria about the basic principle of radiation protection ALARA (As Low As Reasonably Achievable) and their knowledge of the radiation doses that children receive during some common radiological procedures. MATERIALS AND METHODS: Two hundred and fifty questionnaires were circulated among paediatricians at the 2012 annual Paediatricians' Association of Nigeria Conference. The questionnaires contain 10 questions designed to asses the pediatricians' general knowledge on : ionising radiation and the risks, doses children receive during some common radiological procedures and awareness of the radiation protection principle, ALARA ( As Low As Reasonably Achievable). RESULTS: Of the 162 Paediatricians that participated, 69% named at least one non medical source of ionising radiation, 54.9% would not recommend CXR to screen an apparently healthy child for tuberculosis and 87% believe that children are at greater risk of adverse effects of ionising radiation. For dose estimation, 51.9% and 51.2% of the paediatricians underestimated doses received during Cranial and abdominal computerised tomography respectively while 13.6% and 37% respectively erroneously believed that abdominal ultrasound and brain magnetic resonance imaging utilise ionising radiation. 13.6% gave the correct meaning of the Acronym ALARA. CONCLUSIONS: The Paediatricians' knowledge about the basic principle of radiation protection ALARA and the doses that children receive during some common radiological procedures is poor. There is need to ensure adequate training on radiation hazards and protection at all levels of medical education.

Relationship of ultrasonographically determined kidney volume with measured GFR, calculated creatinine clearance and other parameters in chronic kidney disease (CKD).

INTRODUCTION: Kidney length has traditionally been used as a predictor of chronic kidney disease (CKD); however, kidney volume (KV) rather than length has been emphasized by researchers as a true predictor of kidney size in states of good health and disease. Since KV can be assumed to be a predictor of kidney mass or remaining surviving nephrons in CKD patients, we theorized that the KV should reflect the functional capacity of the kidneys, i.e. the glomerular filtration rate (GFR). METHODOLOGY: Forty CKD patients were recruited and investigated. Measured GFR was determined by calculating the average of endogenous creatinine clearance (mCrCl) and urea clearance (mUrCl) while predicted GFR was determined using Cockcroft and Gault, Hull and Modification of Diet in Renal Disease (MDRD) equations. KV was assessed ultrasonographically using the formulae of Dinkel et al. and Solvig et al. for ellipsoid organ. The relationship between the KV and GFR was assessed using Spearman's correlation coefficient while Bland and Altman tests were used to assess intraobserver variation and agreement between measured and predicted GFR. RESULTS: The results showed a weak but positive correlation between KV and various indices of GFR, best with measured CrCl (correlation coefficient ranged between 0.408 and 0.503; P < 0.05), and which was not improved after normalization for body surface area (BSA). We also found a significant correlation between the measured CrCl and various values of estimated CrCl. CONCLUSION: Ultrasonographically determined KV was found to correlate with GFR and hence can be used to predict it in established CKD, particularly in resource-poor settings.

Complete recovery of renal allograft function after sixty days of delay following living related transplantation.

Delayed graft function (DGF), a term employed when a newly transplanted organ does not function efficiently is commonly observed following cadaveric renal transplantation but is very rare after living related transplants. We present a 31-year-old female recipient of a related donor kidney (mother) who had DGF following trans-plantation due to acute tubular necrosis, probably caused by partial allograft arterial thrombosis, which recovered function after 60 days. Appropriate use of allograft biopsy should be encouraged even in resource-limited settings lest the allograft be assumed to have failed irreversibly.

Rickets of prematurity- a case report.

OBJECTIVE: This case report seeks to create awareness of the aetiology of rickets of prematurity among very low birth weight infants in Nigeria METHODS AND RESULT: This is a case report of an 800 gramme premature male neonate delivered by caesarean section at 28 weeks gestation following severe maternal pre-eclampsia. The infant was hospitalised for sixty days and fed exclusively on his mother's breast milk for seven months. He had two episodes of sepsis and was transfused twice while on admission. He was on Abidec drops, which contained 400 IU/0.6 ml of vitamin D from the age of two weeks. He defaulted from the follow up clinic at postnatal age of 16 weeks only to reappear at 30 weeks postnatal age with overt clinical, biochemical and radiologic signs of rickets. He responded well to calcium and phosphate supplementation. CONCLUSION: This case highlights the role of mineral deficiency in the aetiology of rickets of prematurity in very low birth weight infants fed with their mothers' breast milk.

African histoplasmosis - masquerading as a malignant bone tumour.

A 23-year-old immunocompetent woman presented with a two-month history of fungating left shoulder and left elbow swellings associated with fever, weight loss and anaemia. X-rays showed lytic destruction of the lateral third of the left clavicle and distal half of the left humerus. Histology of biopsy specimen confirmed African histoplasmosis. The lesion resolved following treatment with ketoconazole.

Successful separation of two pairs of conjoined twins in Ile Ife, Nigeria: case reports.

Conjoined twins are rare phenomena occurring in one in 1 in 50,000 live births. Successful surgical separation of conjoined twins is a major undertaking requiring careful planning by a multidisciplinary team. Reports of seperation of joined twins in developing countries like Nigeria are rare. Ten cases of conjoined twins were separated between 1936 and January 2003 (including the authors two new cases). There were five omphalopagus, two pygopagus, two heterpagus and one ishiopagus twins. Three underwent emergency separation with 83.3% mortality while seven underwent elective seperation with 64.3% survival. The overall mortality rate was 50%. Despite the absence of advanced technological resource selected group of conjoined twins can be successfully separated in a developing country like Nigeria. An improvement in facilities and availability of trained personnel in likely to be associated with improved outcome.

Chronic hepatitis in Nigerian patients: a study of 70 biopsy-proven cases.

BACKGROUND: Liver cirrhosis and hepatocellular carcinoma are known sequelae of chronic hepatitis. Early diagnosis and treatment of chronic hepatitis could delay or even abort progression to terminal liver disease. STUDY DESIGN: Prospective study of 70 consecutive patients with features of early liver disease or discovered with HBsAg (or anti-HCV) during pre-employment and/ or pre-donation screening at Ile-Ife, Nigeria. All the patients had liver biopsy and the histology evaluated with the Knodell Histological Activity Index. RESULT: Fifty-three patients had symptomatic disease (M: F ratio, 1.5:1) while 17 were asymptomatic (M: F ratio, 3:1). The mean ages were 49.04 (SD+/-16.78) and 29.82 (SD+/-6.13) for the symptomatic and the asymptomatic patients respectively (P< 0.005). Major symptoms were right upper abdominal pain (68%), weight loss (51%) and fatigue (41.5%). Alcohol consumption was significantly related to symptomatic chronic hepatitis (P< 0.01). Over 50 % of patients with asymptomatic chronic hepatitis had abnormal liver scan and liver function tests. All the asymptomatic cases and 77.4 % of the symptomatic group had HBsAg while only 1 patient (symptomatic) was anti-HCV positive. On liver histology, all the patients with asymptomatic chronic hepatitis had a Knodell score of< or = 8 and none had fibrosis. Over half of the symptomatic patients had a Knodell score of > or = 9 (56.6%) and stage 2 or 3 fibrosis (51 %). CONCLUSION: Asymptomatic chronic hepatitis patients tend to be younger and of the male sex. Symptomatic chronic hepatitis may signal the onset of significant fibrosis and alcohol abuse may accelerate this process. Serum ALT and liver scan are useful initial screening tests for asymptomatic patients with hepatitis B or C viral markers.

Burkitt's lymphoma of the head and neck region in a Nigerian tertiary hospital.

BACKGROUND: Burkitt's lymphoma is endemic in Nigeria; it forms about 39% of all childhood cancers. In recent times more of these cases are being seen presenting first to the Ear Nose and Throat clinic. OBJECTIVE: This study is designed to look at the pattern of presentation of head and Neck Burkitt's lymphoma at a Nigerian Tertiary hospital and to evaluate current treatment modality. DESIGN: It is a retrospective study of all confirmed Burkitt's lymphoma of the head and neck region seen at the Obafemi Awolowo University Teaching Hospital Ile Ife (OAUTHC) between 1986 and 2002. PATIENTS AND METHODS: The medical records of all the patients with the histopathologically confirmed Burkitt's lymphoma over a 17-year period (1986-2002) were evaluated. The proportion of the tumor affecting the Head and neck region were noted. The data extracted were entered into a questionnaire and analysis of data was done using the SPSS 10.0 software. RESULTS: A total of 196 cases of Burkitt's lymphoma were seen over the period out of which 140 (71.4%) were in the head and neck region. There was a male preponderance with the incidence of 72% and 28% in females. The peak age incidence was found to be within the first decade of life. The most common sites that were affected are; the jaw (65.9%), nasal and paranasal sinuses (12.2). Majority of the patients presented with advanced disease. Combination Chemotherapy comprising Cyclophosphamide, Oncovin, Methotrexate and Prednisolone (COMP) was the mainstay of management. The treatment outcome was only favorable in 36.6%. Default rate was (11.7%) while the mortality rate was (12.6%). Relapse\recurrence was found in (5.1%) of cases. Frank drug resistance was found in (2.6%). Blindness was found to be a major morbidity associated with this disease. Septicemia and severe anemia were found to be the major causes of mortality. Some complications of treatment were noted. DISCUSSION: The importance of the findings in this work was discussed in line with the existing literature. CONCLUSION: Head and neck remain the mostly affected parts in Burkitt's lymphoma in this environment. Presentation with advanced disease is the bane. This partly explains high morbidity and mortality in affected children.

Pulmonary alveolar microlithiasis--a case report.

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown aetiology. It is characterized by the presence of calcific concretions (calcospherites) inside the alveoli. We present a case of a 22 year old sickle cell anaemia patient with an incidental finding of PAM. This report is to highlight the fact that though rare, PAM is not entirely unheard of in this environment and should be kept in mind as a cause of diffuse opacities of the lungs.

Kidney transplantation in a developing economy: challenges and initial report of three cases at Ile Ife.

BACKGROUND: Kidney transplantation (KT) is globally adjudged the best alternative treatment for end stage renal disease (ESRD) in preference to life-long dialysis. This form of therapy was hitherto unavailable in Nigeria until our hospital and a private hospital embarked on a KT programme despite our depressed economy, and inadequate facilities. We present the initial report of KT performed in our hospital and the challenges of KT in our developing society. CASE REPORTS: Three patients with ESRD had living related KT between June 2002 and April 2003. The first patient died with functioning graft six and a half months post transplantation from complications of Diabetes mellitus and sepsis, while the remaining two still enjoy a good quality of life 35 months post transplantation. There were problems with procurement and monitoring of immunosuppressive drugs in the three patients. This report also illustrates the common causes of ESRD in Nigeria and some of the complications of KT. To our knowledge, these are the first reported cases of KT in Nigeria. CONCLUSION: Kidney transplantation is cost effective and offers a good quality of life for ESRD patients. Poverty, inadequate facilities and lack of donors are major problems facing KT in our society. Although KT requires high technical and material resources, with proper training, commitment and adequate funding, it is feasible, safe and cheaper on a long term basis for the management of patients with ESRD in a developing economy like ours. There is a need for government funding of KT programmes in developing countries.

Exudative retinal detachment occurring in a patient with pyogenic liver abscess.

This is a report of a rare case of bilateral exudative retinal detachment occurring in a young Nigerian male with pyogenic liver abscess. Detailed ocular and clinical examination with biochemical, haematological and microbiological studies of the blood and liver aspirate were done. Ocular and abdominal scan plus surgical drainage of abscess were also done. The main features were febrile illness with hepatomegaly and sudden loss of eyesight. Visual acuity was light perception in both eyes. The cardiovascular and renal systems were normal. Ocular scan showed bilateral bullous retinal detachment while abdominal ultrasound revealed multiple liver abscess cavities. HIV and HBsAg tests were negative. Pyogenic liver abscess should be regarded as possible cause of exudative retinal detachment and has a potential blinding complication.

Primary hepatocellular carcinoma in Ile-Ife, Nigeria: a prospective study of 154 cases.

Primary hepatocellular carcinoma is a tumour with a dismal prognosis. In recent times, however, great advances have been made in its management. This 13-year prospective study done at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, was an attempt to appraise the outlook of the disease in Nigeria at the turn of the 21st century. Primary hepatocellular carcinoma affected mainly middle-aged Nigerians (peak age-group = 40-59 years), predominantly males (M:F = 2:1) and, in a sizeable proportion (78%), it co-existed with cirrhosis. Significant risk factors found were scarification marks (87%), anicteric hepatitis (71.3%), abuse of medicinal herbs and analgesics (68.6%) and injection from quack doctors (51%). Blood test for HBsAg was positive in 61% of patients. The mean duration of symptoms. before diagnosis was 12.64 weeks (SD 13.77) while, on the average, patients died within 14.0 weeks (SD 13.0) of illness, usually of liver failure (67.7%). Only symptomatic treatment could be offered in 148 patients (96.1%) while chemotherapy was merely attempted in 5 (3.25%). Majority of the patients (59.8%) were either discharged against medical advice or lost to follow-up. This study shows that Nigerian patients presenting with primary hepatocellular carcinoma already have advanced disease and this makes treatment and survival hopeless. Universal immunisation with HB vaccine should be implemented in Nigeria without further delay and health education should be directed against socio-cultural practices which are aetiological risk factors for primary hepatocellular carcinoma.