MAGNETIC RESONANCE IMAGING PATHOLOGICAL EVIDENCE IN PATIENTS WITH LOW BACK PAIN IN SOUTHWEST NIGERIA.

BACKGROUND: Low back pain, a condition that affects many individuals worldwide during their lifetime is receiving increasing attention due to the attendant chronic disability, absenteeism from work, loss of earning power, loss of quality of life and finances. Recently focus has been on the rising prevalence and search for steps to address low back pain risk factors now known to be modifiable. For the evaluation of low back pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice. AIM: To determine the prevalence and distribution of lumbosacral spine discs, osseous, ligamentum flavum and facet joint changes evaluated by MRI. And to further understand the lumbosacral spine biomechanics of MRI-related disco-osseous abnormalities among native African population with low back pain. STUDY DESIGN: This was a retrospective study. SETTING: University College Hospital, Ibadan, Nigeria. METHODOLOGY: The Lumbosacral spine T1W and T2W sagittal and axial images and post gadolinium contrast images generated using a low field MRI scanner and body surface coil, in patients with low back pain, were evaluated in line with pre-defined spinal changes. RESULTS: There were a total of one hundred and eight low back pain patients who had Magnetic resonance imaging between March 2015 and August 2016 in this study with a mean age of 49.9 years and a range of 8 to 77 years. There were 28(25.9%) patients aged 50 - 59 years; this age bracket had the highest number while those aged 20 years and below were 3.7%. In all, 80(74.1%) subjects had chronic low back pain. Abnormal Magnetic resonance findings were reported in 96.3%. Multiple disc affectation was seen in 75.3%; disc bulge (79.8%) was the commonest disc findings followed by dehydration in 74.0%. The L4/5 discs were commonly affected in disc dehydration in 59(76.6%) cases, anterior herniation in 22(61.1%) cases, ventrolateral herniations in 9(81.8%) cases, nerve root compression in 21(60%) cases, facet joint hypertrophy in 17/24(70.8%) cases and spinal canal stenosis in 32/47(68.1%) cases. Vertebral end plate changes occur mostly at L4 and L5 (74% at each level). CONCLUSION: This study has shown that Magnetic Resonance Imaging changes in low back pain involved multiple discs and multilevel osseous pathologies, however, disc abnormalities are predominant. The L4-5, L5-S1 disc levels and L4 vertebra body were the most commonly affected sites among a native African population.

Helical CT myelogram: the Ibadan initial experience.

To evaluate our initial experience with Helical Computed Tomography (CT) Myelogram in the investigation of spinal abnormalities. As late as 1980, CT was still regarded as unreliable compared with myelography however, the advent of slip-ring technology in the 1990s, in association with the use of more powerful computers and higher energy x-ray tubes allowed a process known as Helical CT. This revolutionized CT scanning allowing achievement of thinner slices in a single breath-hold. Helical CT myelogram is one of the recent applications with the potential of improving clinical diagnosis in patients with spinal disorders. This is a descriptive study of 56 patients who had a CT myelogram in the first 15 months of operation of a helical CT scanner at Ibadan (January 2004-March 2005). Axial scans were done after a lumbar puncture with injection of 8-10 mls of contrast (iopamidol). Demographic, clinical data and CT findings were analyzed. Patient ages ranged from 3 to 75 years. The highest age frequency was seen in the 4th and 5th decade. 37 (66%) of these patients were males and 19 (34%) were females. The majority of scans, 22 (39.2%) were in the thoracic and thoraco-lumbar regions. Low back pain was the most common indication 26 (32.1%) followed by paraplegia 24 (29.6%). Spinal cord compression and spondylosis represented 34% and 20% of the CT findings respectively. Helical CT myelogram is a valuable investigative tool which demonstrates spinal abnormalities well by providing a good silhouette image of the spinal cord.

Stroke in Nigerian children with sickle cell disease.

We reviewed our records over a 15-year period to determine whether or not the impression that stroke complicating sickle cell disease was less common than reported in North America. Records of children aged 16 years and below with a diagnosis of stroke seen at the University College Hospital, Ibadan, Nigeria between 1988 and 2002 were examined. Thirty-nine such patients were identified but only 31 had detailed records available for study. Twenty-seven of these had sickle cell disease, 26 with haemoglobin genotype SS and 1 with Hb S+C. Sickle cell disease was therefore responsible for 87% of stroke seen in children at our centre. With an average clinic population of about 500 patients with sickle cell disease, the hospital frequency of stroke among these patients is estimated at 5.4%. The mean age of occurrence of the first stroke was 6.8 years ranging from 17 months to 11 years. Of the 7 patients who had CT scans of the brain done, 5 had evidence of cerebral infarction while 2 had intracerebral haemorrhage. While only 2 deaths occurred among the cases reviewed, morbidity was significant with only 6 patients achieving complete recovery. Recurrent stroke occurred after an average of 25.6 months in 8 of 13 patients who were followed up (61.5%). The incidence of stroke among African children with sickle cell disease appears to be not as high as reported in patients from North America.

TIME OF PRESENTATION OF STROKE PATIENTS FOR CT IMAGING IN A NIGERIAN TERTIARY HOSPITAL.

BACKGROUND: Neuroimaging is the cornerstone for guiding thrombolytic and interventional therapy for stroke. Beneficial outcome can only be obtained within a rather short time of less than 3-4.5 hours of symptom onset. Challenges in developing countries like Nigeria often lead to delayed presentation of stroke patients in hospitals. We sought to study the time and pattern of presentation of stroke patients for CT imaging in a Nigerian tertiary hospital. METHODS: Of the 271 stroke patients who had cranial CT between 2008 and 2010, eighty-three (30.6%) with full retrievable CT records, were included in this study. They were categorized into six time groups cross-tabulated with their CT findings. RESULTS: Forty-two patients (50.6%) had cerebral infarction while 23 (27.7%) had haemorrhagic stroke. However, 18 (21.7%) patients had apparently normal CT findings. The mean presentation time for CT imaging was 70 hours (SD ±94 hours). Only 31% of all stroke patients presented for CT imaging within 12 hours, and none, within 3 hours. Forty-six percent did not present within 24 hours of symptom onset. Significantly more patients with ischemic stroke (72.3%) than hemorrhagic stroke (27.7%) presented after 12 hours of ictus (X(2) = 4.027 d=1, P =0.045). Age (X(2)=0.008, P =0.931) and gender (X(2)1.742, d=1,P =0.187) had no statistically significant relationship with the time of presentation for CT imaging. CONCLUSION: None of our patients met the time criteria for thrombolytic therapy. Ischemic stroke patients presented for imaging later than patients with intracerebral haemorrhage. There is a need to increase the awareness regarding early recognition, presentation and diagnosis of stroke for timely intervention in Nigeria.

Sarcoidosis in Africans: 12 cases with histological confirmation from Nigeria.

During a 2 year-period 12 Nigerians with sarcoidosis were diagnosed at the chest and dermatology clinics of the University College Hospital, Ibadan, Nigeria. Intrathoracic involvement was the commonest presentation followed by the skin, lymph nodes and liver. Histological diagnosis was obtained in all cases either from skin biopsy, transbronchial lung biopsy, lymph node or liver biopsy where applicable. This study suggests that sarcoidosis is not as rare as previous literature on the subject portrays.

Occult metastatic follicular thyroid carcinoma masquerading as a soft tissue sarcoma of the gluteal region.

This is a case of an occult follicular thyroid carcinoma in a 61 year old civil servant presenting with bony metastasis to the left iliac bone twenty years after an initial subtotal thyroidectomy. There was a soft tissue mass with associated cup shaped Iytic detruction of the iliac bone and on ultrasound scan the mass was found to be of mixed echogenicity and areas of sonolucencies which were due to necroses. At autopsy, the thyroid gland appeared macroscopically within normal limits but histology confirmed Follicular Thyroid Carcinoma.

The place of clinical features and standard chest radiography in evaluation of mediastinal masses.

One hundred and five primary mediastinal masses were seen between 1975 and 1998, at the Cardiothoracic surgical Unit of the University College Hospital Ibadan. These were studied to establish the importance of clinical features and plain chest radiography in preoperative evaluation of these masses. The sources of information were unit's record, cancer registry and the patients case note. The age range of the 75 male patients was 3 to 80 years (mean 35.2 +/- 22.1 year) and for the 30 female patients was 2.5 to 70 years (mean 30.9 +/- 18.6 years). Anterosuperior mediastinal masses were the most common (63.8%) followed by posterior mediastinal masses (22.9%). Middle mediastinal masses made up the remaining (13.3%). The most common primary mediastinal tumour was lymphoma (21.9%) next to which were thymus gland neoplasia and thymus cysts/hyperplasia (18.1%). Endocrine tumours (mainly goiters) constituted 17.1% of the masses. On the whole, 45 (42.9%) of the mediastinal tumours were malignant and 60 (57.1%) were benign. Eighty one patients (77.1%) were symptomatic at presentation, 24 patients (22.9%) were asymptomatic. Malignancy was more associated with symptoms in this series (82.2%) and benign lesion were more frequently (70.8%) asymptomatic. Cervical lymphadenopathy (78.6%), was more frequent in patients with malignant lesion. Tracheal deviation (60.3%) and neurological signs (78.9%) were more frequent in benign disease. Superior vena cava syndrome was more frequently associated with primary malignant mediastinal tumours. All masses (100%) were visualized on plain chest x-ray. On the basis of clinical features and chest x-ray, majority of patients (76.2%) with primary mediastinal masses had exploratory thoracotomy, sternotomy or biopsy of their mediastinal mass.

Ultrasonic foetal abdominal circumference as a means of assessing gestational age in Nigerians.

Foetal abdominal circumference values have been established amongst pregnant Nigerian women between 16 weeks and 40 weeks of gestation, using standard ultrasound methods. A linear mathematical model was found to be adequate in describing the relationship between gestational age and abdominal circumference, and by using the regression equation from the data it was possible to predict the gestational age from knowledge of the abdominal circumference and vice versa. The value of this parameter in assessing foetal age and monitoring high risk pregnancies is discussed.

Subcutaneous emphysema and pneumomediastinum complicating endotracheal intubation--a case report.

A case is reported of a 5-month-old child who developed subcutaneous emphysema and pneumomediastinum following the application of external pressure on the trachea during intubation using a non-kinkable tube with a stylet in situ. Possible aetiological factors and management of such a condition are discussed.

Intrapartum rupture of the uterus diagnosed by ultrasound.

BACKGROUND: Spontaneous uterine rupture is a life threatening obstetrical emergency encountered infrequently in the emergency department. Its diagnosis is often missed or delayed, leading to maternal and fetal mortality. METHOD: We present a case of ruptured uterus diagnosed by ultrasound in a 33-year-old gravid female with two previous cesarean sections. OBJECTIVE: To show the role of ultrasound in uterine rupture RESULT: Ultrasound demonstrates uterine laceration and intra-abdominal dislocation of placenta and foetus CONCLUSION: Because of the severity of the complication and the great variation of symptoms in connection with it, the authors encourage the use of ultrasound screening in the detection of this rare, but often catastrophic complication.

Posterior Urethral Valves with Severe Unilateral Vesicoureteral Reflux in a 3-year-old Boy.

In patients with posterior urethral valves (PUV), severe unilateral vesicoureteral reflux (VUR) is one of the three conditions associated with preservation of renal function. Others are urinary ascites or urinoma in newborns and large congenital bladder diverticula. These conditions most likely provide a pop-off mechanism preventing the development of high intravesical pressure. Only 5% of patients with PUV and an associated pop-off mechanism will develop renal failure as opposed to 40 % of patients with PUV without a protective factor. We present a 3-year-old boy with posterior urethral valves and a severe right unilateral vesicoureteral reflux. He had PUV ablation with Mohan's valvotome and made satisfactory post operative recovery with indication on follow-up of preservation of renal function.