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   Table of Contents - Current issue
Coverpage
July-December 2021
Volume 28 | Issue 2
Page Nos. 31-69

Online since Friday, February 11, 2022

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ORIGINAL ARTICLES  

Age-related ultrasonographic mammary gland density patterns: Implication for breast cancer risk p. 31
Nicholas Kayode Irurhe, Nwachukwu Mike Ibeabuchi, Omodele Abosede Olowoyeye, Ogechi Augustina Ihekuna, Oluwaseyi Jessy Balogun, Caleb Itopa Yakubu, Francis Ikechukwu Duru
DOI:10.4103/wajr.wajr_10_21  
Introduction: Mammary gland/breast density is important because it is a known biomarker for breast cancer risk. However, the sensitivity of mammography decreases with high breast density found in younger age group. Ultrasound is considered as the first-line examination in the classification of breast density and in the detection and characterization of breast lesions. This study aims to evaluate the relationship between age and ultrasonographic breast density pattern and its implication for breast cancer risk. Materials and Methods: This was a community-based cross-sectional, exploratory, descriptive study involving 658 females. Breast ultrasonographic scans were performed using a Sonoace X1 Machine with a 7.5 MHz transducer. The lesions detected and classified by ultrasonography as benign or malignant were further subjected to cytopathology. Results: Modal age group of the participants ranged from 33 to 43 years representing 29.8%. There was significant correlation (P<0.01) between ultrasonographic mammary gland density pattern and age, the age group of <33 years demonstrated predominant fibroglandular density pattern with mostly benign lesions, while the age group of 33–53 years demonstrated predominant heterogeneous breast density pattern with most of the malignant lesions in this age group, making it the high-risk group for breast cancer. Conclusion: The relationship between age and ultrasonographic breast density is inversely proportional and not absolute. It also concludes that ultrasonography is a reliable screening tool in the diagnostic process for mammary gland lesions, and as an imaging tool, it is the preferred modality in dense breast. The heterogeneous fibroglandular pattern emerged as the high-risk group for breast cancer, especially in middle age.
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Evaluation of the diagnostic yield of ultrasound in the management of appendicitis: An experience in a tertiary hospital in South-Eastern Nigeria p. 36
Hyacienth Uche Chiegwu, Daniel C Ugwuanyi, Benjamin E Udoh, Francis S Chianumba
DOI:10.4103/wajr.wajr_17_20  
Introduction: In most complaints of right lower abdominal pains appendicitis is suspected. Appendicitis often creates the most common abdominal surgical emergency. Ultrasound and computed tomography are often the imaging modalities used to confirm the clinical diagnosis of appendicitis. The aim of this study was to evaluate the accuracy of ultrasound in the diagnosis of appendicitis in a tertiary hospital in South Eastern, Nigeria. Materials and Methods: A retrospective study design was adopted to study 152 records of patients aged 1–65 years who had ultrasound scans for clinical suspicion of appendicitis at a tertiary hospital in Anambra State, South Eastern Nigeria from 2016 to 2018. Patients' age, gender, and provisional diagnosis were obtained from the patients' request forms. Ultrasound results were obtained from the radiology department and the histology reports from the histology unit of the hospital. The Statistical Package for the Social Sciences, SPSS, version 22.0. was used for data analysis. Results: Of the 152 cases, ultrasound was positive in 115, while histology confirmed 136 positives. Ultrasound, therefore, had a sensitivity, specificity, and accuracy of 84.56%, 100%, and 86.18%, respectively. The positive predictive value and negative predictive values were 100% and 43.24%, respectively. The study showed a higher incidence of appendicitis among females (n = 84) than males (n = 52), (ratio 1:1.6). Age groups 10–19 and 20–29 years were the most affected. Accuracy was 91.94% (in males) and 82.22% (in females). The most common ultrasound features include enlarged appendix (>9 mm, 100%), rebound tenderness to probe (92%), and fluid-filled appendix (88%). Conclusions: Ultrasound has high sensitivity, specificity, and accuracy for the diagnosis of appendicitis.
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Opportunistic use of “follow-up” chest and abdominal computed tomography in the assessment of bone mineral density of breast cancer patients in a resource-poor nation p. 42
Yaw Boateng Mensah, Clement Edusa, Josephine Nsaful, Naa Adjeley Mensah, Augustina Badu-Peprah, Hafisatu Gbadamosi, Andrea Appau, Adu Tutu Amankwa
DOI:10.4103/wajr.wajr_20_21  
Background: Breast cancer patients experience bone loss from treatment-induced menopause, as well as from the direct effect of cancer. The use of computed tomography (CT) attenuation values of the lumbar spine to estimate bone mineral density has been validated by several studies. Materials and Methods: This was a retrospective study conducted at Sweden Ghana Medical Centre and Korle Bu Teaching Hospital between June 2016 and August 2019. Measurement of Hounsfield unit (HU) of lumbar vertebrae was achieved by drawing an elliptical region of interest (ROI) on an axial image of the vertebra about 2–3 mm from the spinal cortical bone. The mean HU of the ROI was measured on bone window for each of the vertebral bodies, and the values were documented and analyzed. Results: The mean bone densities of the vertebrae were generally higher for the noncancer patients compared to the breast cancer patients for all the age groups. The measured bone densities showed a normal distribution curve. The range of bone density for osteopenia and osteoporosis was between 174.4 and 236.4 HU and <174.4 HU, respectively. A Pearson's correlation analysis between patient age and bone density for both groups showed a negative statistically significant relationship. Conclusion: Using CT attenuation values of lumbar vertebra to estimate bone density established that the bone densities follow a normal distribution, the mean bone density for breast cancer patients were slightly lower than for noncancer patients, and age correlated better with lumbar bone density in noncancer patients than in breast cancer patients.
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A comparative control study of ophthalmic artery Doppler velocimetry in patients with primary open angle glaucoma in Kano, Nigeria p. 47
Adamu Ibrahim Gombe, Isyaku Kabiru, Ismail Anas, Yahuza Mansur Adamu, Hassan Sadiq
DOI:10.4103/wajr.wajr_27_20  
Objective: The objective of the study is to sonographically determine the hemodynamic changes in ophthalmic arteries of patients with primary open angle glaucoma (POAG) at Kano, Nigeria. Subjects and Methods: We conducted a prospective case–control study at Aminu Kano Teaching Hospital, Nigeria, on 108 newly diagnosed POAG and 108 control subjects. Intraocular pressure (IOP) and Doppler ultrasound velocimetry of ophthalmic arteries were assessed. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistive indices (RIs), pulsatility indices (PIs) and systolic/diastolic (S/D) ratios of the ophthalmic arteries were evaluated and documented. Results: The mean IOP values of POAG group in the right and left eyes were higher than the values of the right and left eyes of the control group. This was statistically significant (P = 0.000). The mean PSV, EDV, RI, PI, and S/D values in the POAG group of the right and left eyes were lower than values for the right and left eyes of the control group, which was also statistically significant (P = 0.000). The IOP showed positive correlation with PSV and EDV in both eyes of POAG cases but negative correlation with PI and S/D in both eyes in the POAG group. It however correlated positively with RI in the right eye and negatively with RI in the left eye. Conclusions: The study showed significant differences between ophthalmic artery Doppler indices of patients with POAG and the healthy control subjects.
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Evaluation of inadequately filled radiology request forms with its impact on patient radiation exposure and waiting time in a tertiary care hospital: A preliminary report from Northwest Nigeria p. 55
Idris Garba, Hussain Shafiu Bashir, Sidi Mohammed, Musa Dambele, Mustapha Shuaibu Hikima, Yusuf Lawal, Mansur Adamu Yahuza
DOI:10.4103/wajr.wajr_5_21  
Background: Adequate and accurate clinical history on a properly filled request form is indispensable if a clinically relevant radiological diagnosis is to be made. Moreover, clinicians need to clearly justify their requests for radiological procedures on a request form to prevent unnecessary radiation exposures and examinations with attendant prolonged waiting time. Objective: The study audited inadequately filled radiology request forms to determine their impacts on diagnosis, patient radiation exposure, and waiting time. Materials and Methods: Following an institutional review board approval, a total of 158 inadequately filled request forms for conventional X-ray examinations were sequentially enlisted and evaluated. Scorings as filled, inadequately filled, and unfilled were used to score each item based on the following: patient biodata/demographic information and patient referral details and referring physician details. Request forms for repeat examinations were further analyzed for remote factors tied to inadequate filling or lack of filling of the details on the repeat forms. Data were analyzed based on descriptive statistics using SPSS statistical software. Results: Patient names including first and surname were adequately filled on all the request cards (100%). Information related to patient referral details such as previous X-ray examination, blood pressure, and last menstrual period were inadequately filled with 4.4%, 2.5%, and 19.7% completion, respectively. Of the 158 request forms assessed, 33 (20.9%) examinations were repeated due to partial or complete cutoff of anatomic region of interest analysis showing inadequate clinical history and requested examination accounting for 45.5% and 24.2% of the remote factors tied to the repeats. Conclusion: The practice of adequate, correct, and consistent filling of radiology request forms was suboptimal with resultant prolonged waiting time and possibly increased exposure among repeat cases. A continued reminder of all referring clinicians needs to be improved to protect patients from prolonged waiting times and unnecessary radiation exposure, for the overall improvement of quality of services. Implications for Practice: Adequate information on the request forms improves diagnostic acuracy, reduced waiting time, and increased overall quality of service delivery.
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CASE REPORTS Top

Case report on the management of failed tunneled hemodialysis catheter insertion: The challenges and utility of fluoroscopy p. 61
Yemi Raheem Raji, Babatunde Ebenezer Osobu, Busayo Isaac Abiola, Oluwafemi Ololade Efuntoye, Ademola Joseph Adekanmi, Samuel Oluwole Ajayi, Abiodun Oludotun Adeyinka
DOI:10.4103/wajr.wajr_7_21  
Hemodialysis vascular access is critical to ensuring adequate hemodialysis sessions. Tunneled internal jugular vascular (IJV) access is a type of intermediate access that has become increasingly useful in low- and middle-income countries, where there are not many vascular surgeons with expertise in arteriovenous fistula creation. We presented a 69-year-old male who had complicated IJV catheter insertion, with the catheter located in the pulmonary vascular bed of the left lung and associated left-sided hemothorax. He was managed by multidisciplinary team of nephrologists, radiologists, and cardiothoracic surgeons, who removed the catheter under fluoroscopic guidance without any complication or need for open thoracotomy. The case highlighted the utility of fluoroscopy in aiding hemodialysis catheter insertion, removal, and management of its complications.
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Mayer-Rokitansky-Küster-Hauser Syndrome: A rare case of a crossed-fused pelvic renal ectopia with variant vasculature and common ureter p. 66
Isa Hassan Muhammad, Anas Ismail, Murtala Yusuf, Nuhu Hassan
DOI:10.4103/wajr.wajr_26_21  
The association of renal abnormalities with Mullerian anomalies is well recognized and assessment of the renal tract forms part of the routine assessment of patients presenting with Mullerian anomalies. This is a case of a 20-year-old nulliparous female who had abdominopelvic ultrasonography on account of primary amenorrhea showing bilateral ectopic kidney fused in the pelvis, complete absence of the uterus, the cervix, and the upper part of the vagina; while normal sized ovaries seen. These were confirmed on computed tomography (CT). Renal CT angiograms showed a renal artery arising anteriorly from the abdominal aorta just above its bifurcation into the common iliac arteries. An interesting feature in this patient was the existence of the median sacral artery in the blood supply of the fused pelvic kidney. No skeletal anomalies were visualized in dorsolumbar spine or pelvis.
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