Background: The chest radiographic appearances of HIV-seropositive patients presenting with pulmonary tuberculosis (PTB) are diverse, creating difficulty in diagnosis and treatment. Determination of the effect of highly active antiretroviral therapy (HAART) on radiographic features of pulmonary tuberculosis among HIV infected patients was investigated in order to find out the pattern in our environment and to provide an empirical approach for early diagnosis and treatment of patients. Aim: The aim of this study is to determine the effect of HAART on radiographic features of pulmonary tuberculosis in HIV-infected patients. Materials and Methods: A cross sectional study of 60 consecutively confirmed HIV- seropositive patients who had been diagnosed of the infection for at least six months before the commencement of this study, aged between 19 and 50 years (Mean ± SD: 32.9 ± 7.15) comprising 22 males and 38 females with newly diagnosed sputum smear positive PTB was conducted at the infectious disease clinic of the University of Maiduguri Teaching Hospital, between March 2010 and February 2011. The subjects were HIV/PTB patients on HAART for at least 6 months before presenting with PTB (32) and HIV/PTB but Antiretroviral (ARV)-naïve who were already confirmed HIV positive for at least 6 months before presenting with PTB (28). Posterior-anterior (PA) and lateral chest radiographs were obtained with film screen at 50-70 kVp in majority of the patients. CD4 + lymphocyte counts were obtained for all the patients. The chest radiographic images were evaluated for the presence of either typical or atypical patterns of PTB. Apical opacities with or without cavitations was considered typical while atypical patterns included miliary, lower or mid-zone consolidation, reticulonodular opacities, pleural effusion, hilar adenopathy and normal radiograph. Results: Majority (78.6%) of HIV/PTB patients on HAART with CD4 counts of ≥ 200 cells/μl had typical pattern of PTB whereas atypical pattern of PTB was significantly seen in HIV/PTB ARV naïve patients with majority of this group of patients (62.5%) had CD4 count of <200 cells/μl (P = 0.001). Conclusion: Majority (78.6%) of HIV/PTB patients on HAART had typical pattern of PTB whereas atypical pattern of PTB was significantly seen in HIV/PTB ARV naïve patients (62.5%) (P = 0.001). We concluded that radiographic patterns of PTB in HIV varied over a spectrum and are related to HIV disease stage and HAART treatment.

Purpose: To determine the clinical efficacy of a local anaesthetic spray of 10% xylocaine in reducing pain and discomfort in patients undergoing high dose rate (HDR) brachytherapy. Patients and Method: Ninety two consenting patients diagnosed with cervical cancer and planned for HDR as part of their treatment were enrolled for the study. Each patient had three sessions of brachytherapy following the standard procedures. In the first session all the patients had brachytherapy in the usual manner with conscious Sedation with parenteral diazepam and pentazocine. For the second and third sessions, they had treatment sessions using conscious sedation and 10% xylocaine spray and a control session using conscious sedation and a placebo spray with 0.9% normal saline (NS) respectively. Visual Analogue Scale (VAS) was used in assessing pain during each of the procedure. Results: Only 80 patients completed the study. Their age ranged from 28-70 years with a median age of 54 years. The pre-treatment VAS median scores in the treatment and the control sessions were similar at 0.275 and 0.200. However, the post-procedure median VAS scores were increased to 6.3 in the control group and 3.2 in the xylocaine-treated group (P < 0.0001). The haemodynamic status including the blood pressure (BP) and pulse rates (PR) were similar pre and post procedure in both groups. Conclusion: Topical xylocaine spray is efficacious in reducing pain and discomfort in HDR Brachytherapy without any appreciable adverse effect.

Introduction: The use of Doppler scan in the evaluation of patients is crucial. Doppler application has found a wide range of utilization in medicine especially in the evaluation of cardiovascular anomalies such as in the detection of peripheral vascular disease and deep vein thrombosis. The aim of this study is to document the patients' presenting complaints and the corresponding Doppler diagnosis made. Materials and Methods: The study was conducted at the University of Benin Teaching Hospital. The patients' data (including Doppler sonographic data) of all the 121 patients who had Doppler scans done within the year 2012 were pooled and analyzed. Consent for the study was approved by the ethical committee of the hospital. Statistical analysis was done using Statistical Package for the Social Sciences software (SPSS version 17.0). Results: There were males 61 (50.4%) and females 60 (49.6%) in the study group. The mean age was 52.9 ± 21 years (minimum age of 7 months and maximum of 100 years). The lower limb was the most common region of the body interrogated, accounting for 69.4% followed by the neck, 16.5%; abdomen, 8.3%; upper limb, 3.3%; scrotum, 1.7% and head, 0.8%. Leg swelling, peripheral vascular disease (PVD) and deep vein thrombosis (DVT) were the most common presenting complaints with a cumulative frequency of 38.8%, whereas PVD, DVT and carotid plaque were the most common diagnosis made with a cumulative frequency of 48.7%. Conclusion: The use of Doppler ultrasound may lead to various important vascular diagnoses, which have profound usefulness in multiple clinical settings, including the emergency management of DVT.

Aim: To evaluate the renal sizes and echogenicity pattern in patients with human immunodeficiency virus (HIV)-associated nephropathy and to correlate renal echogenicity with serum creatinine levels and proteinuria. Materials and Methods: A cross-sectional study of 100 consecutively confirmed HIV- seropositive patients aged between 19 and 65 years (Mean ± SD: 35 ± 10.79) comprising 32 males and 68 females with clinical and laboratory features of HIV-associated nephropathy (HIVAN) was conducted at the Infectious Diseases Clinic of the University of Maiduguri Teaching Hospital, between April 2011 and September 2012. The subjects were evaluated with renal ultrasound scan and the observed abnormalities were recorded. Serum creatinine levels and CD4 + lymphocyte counts were also obtained for all the patients. Proteinuria was established by dipstick method. Results: Of the 100 cases studied, ultrasound showed enlarged kidneys in 28 patients (28%) and abnormal echogenicity was present in 192 kidneys (96%). 100 kidneys (50%) were globular, 160 kidneys (80%) had decreased corticomedullary definition, 90 kidneys (45%) had decreased renal sinus fat and 80 kidneys (40%) had heterogenous renal parenchymal patterns. A high serum creatinine level, increased degree of proteinuria, lower CD4 counts, reproductive age group and black race were associated with HIVAN. Conclusion: The severity of HIVAN as indicated by raised serum creatinine level and proteinuria correlated positively with the degree of renal echogenicity.

Context: Left ventricular function in HIV/AIDS patients from South-East Nigeria has not been reported. Aims: We sought to determine the prevalence and spectrum of left ventricular function abnormalities in patients with HIV infection in the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Settings and Design: This was a descriptive, cross-sectional study of patients with HIV/AIDS at UNTH, Enugu from September 2006 to July 2007. Methods and Material: Sixty-six HIV-infected patients being managed at the antiretroviral therapy clinic and who had no other cardiovascular risk factor other than HIV infection were consecutively recruited. They were matched for sex, and age with seronegative healthy controls. Clinical and echocardiographic evaluation was carried out to assess the left ventricular function. Statistical Analysis Used: The findings were analyzed with statistical package for social sciences (SPSS) version 10.0. Results: The patients consisted of 29 males and 37 females aged between 23 and 62 years. Left ventricular systolic dysfunction was identified in 9 (13.6%) of 66 HIV-infected patients and 1 (4.3%) of 23 controls (P = 0.201) while left ventricular diastolic dysfunction (reversed fi lling pattern) was identifi ed in 19 (28.8%) and 3 (13.0%) of the HIV-infected patients and controls, respectively (0.021). Left ventricular hypertrophy was seen in 2 (3.0%) patients but in only 1 (4.3%) control (P = 0.647), while left ventricular dilatation was absent in all the patients and controls. Conclusions: Systolic function does not vary significantly between our patients with HIV/AIDS and sero-negative controls. This calls for further investigation of cardiac function in Nigerian HIV/AIDS patients.

Primary intraventricular meningiomas (IVM) are rare, and are even less seen in men. There are only very few reports in Nigerian medical literature and in our hospital, this report is the first. We present herewith a 35-year-old man with clinical suspicion of pituitary macroadenoma on account of headache and visual impairment. He had Magnetic Resonance Imaging (MRI) and histological diagnosis of intraventricular meningioma. This case highlights the value of presurgery MRI as well as the characteristic MRI features which could enable a noninvasive diagnosis. The patient had successful surgical removal and has been followed-up for 2 years.

About 1% of pregnancies is in an ectopic location with implantation not occurring inside of the womb, and of these 98% occurs in the Fallopian tubes. However, implantation can also occur in the cervix, ovaries, and abdomen. Ultrasound scan was performed on a 19-year-old nulliparous female at the Ultrasound Unit of Crystal Specialist Hospital, Lagos, Nigeria. The patient had complained of abdominal pain and vaginal bleeding. Transabdominal scan revealed an empty uterus and extra-uterine embryo implanted in the right adnexa. The fetal pole had a crown-rump-length (CRL) of 13 mm and the gestational age (GA) was 7 weeks 4 days; expected date of delivery (EDD) was 04/03/14. Ectopic pregnancies are usually associated with maternal morbidity and mortality resulting from complications. This case highlights the importance of ultrasound sonography in obstetrics and its adjunct purpose in the preoperative diagnosis and management of ectopic pregnancy.

Wilson's disease can manifest as neurological disorder without hepatic involvement. However, first presentation as status epilepticus is extremely rare. Herein, we report a case where a 21-year-old male presented with status epilepticus. Clinical background, biochemical tests and typical magnetic resonance imaging findings in the form of "Face of giant Panda sign" confirmed the diagnosis of Wilson's disease.

The cobra head sign is classically seen when a unilateral intravesical ureterocele is present. This type of ureterocele is also termed orthotopic. Orthotopic ureteroceles are usually unilateral and commoner in females, but bilateral in 10% of cases.The cobra head sign is characterised by bulbous dilatation of the distal end of the ureter with a surrounding radiolucent halo seen within the contrast-filled urinary bladder on intravenous urograms. Although, the cobra head sign is classic for an intravesical ureterocele, only about 50% of cases show this sign. This is a rare case of an eleven-year old boy with giant bilateral ureterocele touching each other on intravenous urogram, hence appearing as 'kissing cobra'.

Hyperostosis of skull base can be observed in tumorous lesions like meningioma or primary bone tumors. Rarely few non-meningiomatous lesions can also cause skull base hyperostosis. We present an interesting case of skull base hyperostosis due to invasive pituitary adenoma with invasion into surrounding structures.

Sacrococcygeal tumors are present most frequently in infancy and childhood. Incidence in the newborn is 1 in 40000 with a female to male ratio of 10:1. It is rare in adults. Less than a hundred cases of teratoma in adults have been documented in literature. Constipation is a common complain; that is refractory to treatment or results in complications such as fecal impaction warrants consideration of occult causes. In most cases, it is diagnosed in childhood, with most descriptions being found in the pediatric literature. It is extremely uncommon for the syndrome to present in adulthood. We report a case of sacrococcygeal teratoma in adult, which has treated in our hospital. The presented case has shown a large thin walled cystic pre-sacral, retro-rectal cystic mass along the intra-luminal recto-sigmoid rounded ball of fecolith. Here, we highlighted the association of sacrococcygeal cystic teratoma in adult male with fecolith, which is rarely documented. So, we should also search the cause of constipation in adulthood, not only in paediatric age-group; that is refractory to treatment or results in complications such as fecal impaction.

We report an interesting and rare case of hemispheric multiple brain abscesses due to Scedosporium apiospermum which developed following neurosurgery and mimicked hemiconvulsion hemiplegia epilepsy syndrome on initial scans. Interestingly all the abscesses were only on the right side of cerebral hemisphere which later on spread to the other side. All the lesions had hemorrhagic walls seen as hypointensities on susceptibility weighted imaging. The patient succumbed to this fatal fungal brain infection.