Background: Uterine and Umbilical artery Doppler ultrasound is an established and safe tool for quantitative analysis of the utero-placental and the feto-placental blood flow in pregnancy. Aim: To evaluate the Doppler indices in the uterine and umbilical arteries of healthy pregnant women. These will serve as baseline values in predicting impaired blood flow velocimetry in hypertensive disorders of pregnancy that leads to serious maternal and foetal health compromise. Methodology: This was a prospective longitudinal study in consenting singleton gestation women. The right and the left uterine arteries and the umbilical arteries were interrogated. Doppler parameters; Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Resistive Index (RI), Pulsatility Index (PI) and the systolic to diastolic ratio(S/D) were obtained from each healthy pregnant indigenous Nigerian women. Pearson's correlation analysis of the relationship between these parameters and selected maternal demographic parameters was done. P < 0.05 was considered statistically significant. Results: The mean of the normal uterine and umbilical arteries values were different from most published reference values from other parts of the World. No correlation between these indices and maternal parameters were found in this study. Conclusion: Uterine and umbilical artery Doppler indices among normal indigenous pregnant African women are different from those from the developed World. Using other reference values may be inaccurate for pregnant women in our environment.

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Craniofacial duplication known as diprosopus is a rare congenital disorder whereby parts or all of the face are duplicated on the head. This is a case of a 1-year-old boy referred to our hospital with an extra eye (third eye) on the left side of the head and an abnormally shaped head, which were noticed since birth. Pregnancy and delivery were uneventful. Apart from routine antenatal medication, there was no history suggestive of ingestion of traditional or other medication during pregnancy. No history of smoking during pregnancy and no history of exposure to radiation. The child was born in a rural area to a “nonconsanguineous marriage.” Examination revealed posterior plagiocephaly, a depressed anterior fontanelle, and a bulging posterior fontanelle. There was an extra eye (third eye) in the left temporal region. Radiologic findings showed the presence of two normally situated bony orbits and two extra orbits in the left temporal region. Well-formed globes were seen in the normal orbits while only one of the extra orbits contained a globe. The importance of prenatal diagnosis is emphasized.

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Objectives: The objectives of the study were to evaluate various sonographic findings in patients with clinically suspected acute appendicitis and its complications; to follow up and confirm sonographic findings by histopathological examination following surgery; and to determine the role of color Doppler sonography in acute appendicitis. Materials and Methods: One hundred patients clinically suspected to have acute appendicitis underwent ultrasound examination using high-resolution transducers; linear array transducers of 7.5–10 MHz and curvilinear transducer of 3.5–5 MHz. The presence of aperistaltic, noncompressible, blind-ended tubular structure with a diameter ≥6 mm in the right iliac fossa was the primary criterion for the diagnosis of acute appendicitis. Other findings such as the presence of appendicoliths, gas within the lumen of appendix, loculated collections, and appendicular phlegmon were also considered. Results: Out of 100 cases recruited for the study, 95 cases underwent surgical intervention in the form of immediate appendicectomy (89 patients), interval appendicectomy (four patients), or drainage of abscess (two patients). On histopathological/surgical correlation, true positive was 85, false positive – 1, true negative – 6, and false negative – 3. The observed sensitivity, specificity, positive predictive value, and negative predictive value of ultrasonography (US) in the diagnosis of acute appendicitis were 96.5%, 85.7%, 98.8%, and 66.7%, respectively, with an overall accuracy of 95.7%. In our study, 75% patients of appendicitis showed hyperemic color Doppler flow. Furthermore, the use of color and power Doppler sonography was more helpful in those patients where it was difficult technically to visualize the entire appendix. Conclusion: Grayscale US should be the first primary evaluation for patient suspicious of acute appendicitis, and color Doppler is an additional modality to increase sensitivity and more accuracy.

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A 57-year-old man presented with recurrent intermittent colicky right flank pain of 1-year duration. Intravenous urogram (IVU) on two separate occasions suggested a right-sided, extrarenal pelvis. However, when pain became recurrent and persistent, he had a non-contrast computed tomography (CT) examination, which revealed a calculus in the renal pelvis. Diagnosis was missed in the initial imaging modalities because apart from the dilated pelvis, there was no evidence of hydronephrosis or calculus seen, hence a diagnosis of extrarenal pelvis. This case report highlights the superior utility of CT in imaging of suspected urolithiasis, especially when the patient remains symptomatic. Radiologists should be wary, especially in symptomatic patients with features of extrarenal pelvis on IVU.

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Tuberculous infection of the scrotum is rare and occurs in approximately 7% of patients with tuberculosis. With the rise in the human immunodeficiency virus pandemic, the incidence of opportunistic extrapulmonary tuberculosis has correspondingly increased, the genitourinary system being the most common affected site. We present a classical case of tuberculous epididymo-orchitis with clinical, sonographic and histopathological (macro and microscopic) findings as well as the precise management plan incorporated. The sonographic imaging overlap with bacterial epididymo-orchitis, malignant testicular lesions and testicular torsion is discussed. Adequate knowledge of this entity is of utmost importance to ensure a meticulous diagnosis and treatment.

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Background: Incidental finding is an observation, not related to the current medical problem. Various incidental findings can be seen in the lumbar spine (LS) magnetic resonance imaging (MRI) taken for evaluation of low back pain. Aims: To evaluate and analyze the spinal incidental findings in MRI LS of patients with low backache. Settings and Design: A retrospective, cross-sectional analytical study. Materials and Methods: All patients (n = 1269, males: 578, females: 691; mean age: 45 ± 15 years) with low backache, who underwent MRI of the LS at a tertiary care hospital in South India, during a period from January 2011 to August 2015. Two radiologists evaluated these examinations for the presence of incidental findings in consensus. We included fatty vertebral hemangioma (FVH), fatty filum terminale (FFT), extraspinal synovial cyst (SC), Tarlov cyst (TC), enostosis, and limbus vertebrae. Statistical Analysis Used: Calculated the prevalence of incidental findings and analyzed the relationship of these incidental findings with patient demographics. Results: Overall, incidental spinal findings were present in 390 patients (30.7%). FVH was the most common incidental finding (n = 205 patients, 16.16%), followed by extraspinal SC (n = 130 patients, 10.2%), and FFT (114 patients, 9%). A pattern of increasing frequency with age noted in the FVH (P = 0.001), TC (P = 0.017), and enostosis (P = 0.008). There was no significant sex predilection for the incidental findings. Conclusion: Incidental findings are common in LS MRI. Understanding on the nature and prevalence of these lesions is essential for the radiologist, for optimal reporting and for the clinician in appropriate interpretation of radiological reports.

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Background: Whitening out of half of the lung field on a chest X-ray is known as opacification of a hemithorax, and its presence usually indicates a significant disease in a patient. This study was done with an aim of finding different etiologies as the cause of complete opacification of a hemithorax on chest radiograph. Materials and Methods: An observational cross-sectional study of patients whose chest radiograph had opaque hemithorax was included and after clinical laboratory and advanced radiological - ultrasonography (USG) and computed tomography investigation of these patients the diagnosis responsible for the complete opacification of half the lung field in chest X-ray was recorded. Results: A total of 30 patients (23 males and 7 females) were enrolled for the study. Out of the 30 patients, 17 involved the left while 13 involved the right hemithorax. Fifteen patients had clear pleural effusion, 13 patients had mass with pleural effusion and 2 patients were postpneumonectomy cases. Mediastinal shift to contralateral side was seen in 18 out of 30 patients having opaque hemithorax. Eleven patients have biochemical features of tuberculosis. All 13 patients with mass and effusion were confirmed to have malignancy on histology. USG could detect malignancy in only ten cases. Chest pain was most frequent symptom and smoking or tobacco habit was associated with 14 cases. Conclusion: Plain pleural effusion was the most common etiology of opaque hemithorax in our study followed by mass with effusion. Among other rarer causes, only pneumonectomy was seen. For other rare causes that may present as opaque hemithorax larger study may be done.

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Introduction: Proptosis and enophthalmos are cardinal signs of many orbito-ocular and systemic diseases which are common in our environment. The need for an imaging parameter that will aid its early diagnosis is necessary as visual compromise is a major consequence if they are not diagnosed and managed early. Aim and Objectives: This prospective study was aimed at using magnetic resonance imaging (MRI), to determine interzygomatic distance, distance between the anterior and posterior borders of the globes and the interzygomatic line (IZL), and then using these parameters to determine the normal position of the ocular globes within the orbits. Methodology: The study was conducted within 6 months spanning November 29, 2011-May 28, 2012, at the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria. The distance between anterior border of the globe (corneal apex) and IZL which is referred to as Hertel-index, distance between posterior border of the globe and IZL, and length of the IZL were measured at the level of the lens for 340 normal ocular globes of 170 patients on T1-weighted MRIs. Results: The normal ranges for the orbital measurements are as follows (mean ± standard deviation): The normal position of the posterior pole of the right globe was 6.34 ± 0.99 mm from IZL (ranged 5.40-7.33) while that of the left globe was 6.56 ± 0.93 mm (ranged 5.63-7.50). All measurements in male patients were significantly higher than those in female patients (P < 0.001) and the position of the right globe within the orbit was significantly different from that of the left for both sexes (P < 0.001). Conclusion: The results obtained from this study may help ophthalmologists, radiologists, and other clinicians to quantitatively evaluate patients with enophthalmos, exophthalmos, or other changes in the orbital morphology.

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Background/Aim: The maxillary sinus is the largest paranasal sinus and represents a complex anatomical structure with significant inter-individual variation. Computerized Tomography (CT) in the assessment of the maxillary sinus yields much more information. The aim of this study is to determine the prevalence, number and location of maxillary sinus septa using CT. Materials and Methods: One hundred and thirty subjects (79 males and 51 females), between 20–80 years, with normal maxillary sinus CT anatomy, from head CT scans carried out at the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, over a period of 5 years, were studied. Head CT scans were obtained from the local data base of the CT machine and back up compact disc from the CT library. Images were taken with Neusoft Dual Slide Helical CT machine, and films were viewed on the computer monitor. Septa were identified as bony projections from the sinus walls into its cavity on axial and coronal slides. Results: In this study, septa were present in 14.23% (37 septa out of 158) males sinuses, while in females, 10.34% (27 out of 102) had septa. The overall prevalence of maxillary sinus septa was 24.62%. Conclusion: Maxillary sinus septa appear common and are capable of complicating sinus membrane surgeries. CT may be useful in surgical evaluation and planning.

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Preoperative diagnosis of the organ of origin in cases of exophytic lesions of liver is difficult and a challenge for the radiologist and clinicians. It needs careful examination and interpretation of radiological findings for correct diagnosis. We present our experience with exophytic liver lesions in four patients diagnosed with hepatocellular adenoma, hepatocellular carcinoma (HCC), cavernous hemangioma, and hydatid cyst, and highlighted these issues.

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Aims: Incidence of cancer is on the increase and the greater proportion of that increase is from developing countries. About 50-60% of the cancer cases will require radiotherapy at least once during the course of the treatment. This paper is an effort to appraise the present radiotherapy capacity to treat cancer in Nigeria and to project its future challenges and development. Materials and Methods: The available radiotherapy centers in Nigeria were identified and information about the types and number of radiotherapy equipments, imaging systems, personnel, and training capacity were obtained. Results: In 2001, there were five radiotherapy centers with six megavoltage therapy machines in Nigeria comprising of five cobalt-60 and one linear accelerator. The population of the country then was 120 million, that is, one therapy machine for a population of about 20 million. By the end of 2010 the number of megavoltage therapy machines has reached eight with one therapy machine situated in each of eight radiotherapy centers, but the population has equally increased to more than 155 million giving only a marginal improvement in the radiotherapy service. Conclusion: There has been an increase of radiotherapy centers in Nigeria however, the number of available facilities is grossly inadequate and there is dearth of trained personnel. Careful and strategic planning is needed to develop manpower capabilities in all fields of specialization related to radiotherapy service in order to adequately care for the multitude of cancer patients.

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Background: Several disease conditions can affect gallbladder (GB) size and wall thickness (WT). Imaging methods are superior to clinical evaluation in assessing GB dimensions. Ultrasonography is a relatively safe, inexpensive and reproducible imaging modality for assessing normal or diseased GB. There are few reports on normal GB dimensions in the Nigerian medical literature. This study therefore set out to contribute to data on GB dimensions among Nigerians. Materials and Methods: This was a prospective study. Three hundred and twenty-two healthy adult volunteers, consisting of 133 males and 189 females were assessed, by ultrasound, following over night fasting. GB length, width, height and WT were measured for each subject. GB-V was calculated by the ellipsoid formula. Data analysis included descriptive statistics and comparison of measurements with biometric parameters. Statistical significance between the variables was done with the Students t-test, with 'P' value set at ≤0.05. Results: One hundred and thirty-three males (41.3%) and one hundred and eighty-nine females (58.7%) were studied. The mean age of subjects was 31.92±11.7 years. The mean values of the length (L), height (H), and width (W) of the GB were 6.16±1.09 cm; 2.75±0.58 cm; and 2.98±0.59 cm respectively. Mean GB-V was 27.2±12.8 cm ³ and WT 0.25±0.04 cm. Age and gender did not significantly influence GB measurements. Conclusions: A normal range of GB dimensions for the Benin City locality has been established. The study confirmed the non-dependence of GB measurements on age and gender.

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Background/Aims: Repeat of X-ray examinations contributes to the radiation burden of patient and waste of resources in most developing countries. This study determined the economic implications of repeated X-ray examinations in 10 selected hospitals in Ghana. Materials and Methods: The study was carried out in July, 2011 using a total of 2785 radiographs from 1685 patients (85.9% adult and 14.1% pediatrics). Of these, 944 (56.0%) were female and 741 (44.0%) male. Reject films were compiled and classified according to the reasons for the reject. Time and cost analyses due to the repeat examinations were also carried out. Results: Out of 2785 radiographs included in the study, 540 representing 19.4% were rejected. The overall reject rate for the individual hospitals ranged from 14.6% to 20.8%. The minimum time wasted by the radiographers in repeating examinations during the 1 month study was estimated to be approximately 135 h representing 17 working days in Ghana. The loss of revenue per month due to 540 rejected/repeated radiographs amounts to approximately $6021 equating to approximately $72,256/annum. Exposure error and poor patient positioning constituted between 52.0% and 23.0% respectively of the overall causes of film rejection and were evenly distributed across the hospitals. Conclusion: Consistent training in radiographic techniques and standardization of protocols as well as quality assurance measures in the hospitals could help overcome the reported exposure error and poor patient positioning and improve revenue savings.

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Background: An analysis of the current radiation oncology facilities status in Nigeria was conducted to establish a comprehensive baseline. Nigeria is the most populated African country with a population of at least 160 million people based on 2006 population census and average annual growth rate of 3.1%. It is also one of the least developed countries as regards radiation oncology resources with inadequate radiotherapy facilities. Many of the patients have little or no access to safe and modern radiation therapy. Purpose: To obtain a better understanding of the status of radiation oncological practices in Nigeria and to help sensitize the Nigerian government and its developmental partners on the way forward. Materials and Methods: The data were obtained mainly through surveys on the availability of major items of equipment and personnel which were conducted in September 2011. The study included only commissioned and functioning public radiotherapy facilities which are 5 in the country. Data were related to number and types of megavoltage machines, trained manpower (Radiation Oncologists, Medical Physicists, Oncology Nurses, Radiotherapy technologists, maintenance engineers and mould room Technicians), treatment planning systems TPS, Brachytherapy equipment, CT Simulator and Conventional simulators. Results: Of over 50 Tertiary Health Institutions (Teaching Hospitals and Federal Medical Centers) in the country, only 5 has Radiation Therapy facilities with 1 megavoltage machine each, 2 located in the north, 2 in the south and 1 in the Federal Capital Territory. The population served by each megavoltage machine ranges from 20 to 40 million per machine based on 2006 census. Most patients have little or no access to radiation oncology services. Some differences in equipment and personnel amongst centers were demonstrated and the shortage of radiation therapy resources was grossly evident. There are 18 Radiation Oncologists, 8 Medical physicists, 18 Radiotherapy technologists, 26 Oncology Nurses, 3 linear accelerators, 2 Co-60 machines, 2 orthovoltage therapy machines, 2 conventional simulators, 2 CT simulators, 2 centers with 3D TPS, 3 LDR and 1 HDR brachytherapy machines and 2 mould rooms. Some centers were found to treat patients without simulators or treatment planning system. Conclusion: A large deficiency exists for radiation oncological services in Nigeria. There are significant deficiencies in the availability of all components of radiation therapy in the analysed centers. Cognisance should be taken of the specific short falls in each centre to ensure that there is expansion of existing centers and creation of new centers especially in every geopolitical zone and major teaching hospitals in the country.

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Background: A retrospective measurement of lumbar lordosis (LL) in normal supine lateral lumbosacral spine radiographs of 27 children aged 0.04-14.00 years. Measurement of the LL may aid in the early diagnosis and management of some pediatric conditions before irreversible neurologic change occurs. They include spondylolisthesis (congenital or acquired); achondroplasia and muscular dystrophies are less common. The sagittal radiographic lumbar lordotic angle is poorly documented in normal pediatric population. Objective: To evaluate the magnitude and age of maximum development of the normal pediatric LL using three different radiographic techniques. Methods: Ferguson (for lumbosacral angle [LSA]), Cobb (for Cobb angle) and tangential radiologic assessment of LL (for TRALL angle) were the methods used. Data were analyzed with SPSS statistics version 20.0 (Chicago, IL, USA). P < 0.05 was considered significant. Results: LSA varied from 15° to 62°, Cobb angle 15-65° and TRALL angle 20-46°. The mean (standard deviation) of LSA, Cobb, and TRALL angles were 35.8 (10.3)°, 35.6 (13.7)°, and 32.3 (7.3),° respectively; the 0.95 confidence interval for the LSA was 27.6-44.5°, Cobb angle 27.2-50.7°, and TRALL angle 26.8-40.1°. Each angle showed no significant gender difference. The major part of estimated adult LL was gained during the first 5 years of life; the second peak occurred in the 11-14 years age-group. Conclusion: In children under 15 years, poor management of pathologies affecting LL can cause irreversible neurologic damage arising from spinal deformity.

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Background: Head injury is a global epidemic which results in fractures of the craniofacial region. Computed tomography (CT) is the gold standard in evaluating the head injured patient. The aim of this study was to assess the causes of head injury resulting in midfacial fractures and to characterize and classify the observed fracture patterns and associated findings on CT. Patients and Methods: Between 2006 and 2008, 300 consecutive patients with acute head injury were evaluated with a helical General Electric (GE CT/e) CT scan machine. Data reviewed included cause of injury, age and gender distribution, types of facial fractures sustained, and associated intracranial and soft tissue injuries. Results: The modal age group of the patients was the 30 to 39 year age group while the mean age was 32.78 years ± 18.51 standard deviation (SD) with a male: female ratio of 8:3. Abnormal CT scans were seen in 244 (81.4%) of the 300 patients studied. Of the 244 abnormal cases, 79 (32.4%) patients had midfacial fractures. The midfacial fractures were grouped according to the proposed classification. Most of the fractures involved the sinonasal complex (SNC; 47.3%), while the remainder was almost equally distributed in the zygomatico-maxillary complex (ZGMC; 24.4%) and orbital complex (OC; 28.3%). Subgroups were assigned depending on the associated CT findings including soft tissue swelling, cranial fractures, and intracranial abnormalities. Conclusion: Road traffic accidents (RTA) continue to be a major cause of head injury and midfacial fractures followed by falls and assault. We have described the CT findings in midfacial fractures following head injury in the study area and suggest a classification system for categorizing these fractures and associated findings.

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Introduction: Intracranial cystic tumors with mural nodule have been extensively studied. None of these studies have established the role of conventional, fractional anisotropy diffusion tensor imaging (FADTI) and dynamic susceptibility contrast magnetic resonance imaging (MRI) in the assessment of grade and type of cystic brain tumors with a mural nodule. Materials and Methods: This was a retrospective cross-sectional study, which was conducted at Severance Hospital. Brain MRI of 15 consecutive patients with a cystic brain tumor with a mural nodule was analyzed. Results: Among the 15 studied patients 11 were females. The age ranged from 12 to 54 years. Six of the patients had high-grade tumors. Most five of the high-grade tumors showed cystic wall contrast enhancement while none was found among the low-grade group. All high-grade tumors showed increased regional cerebral blood volume (rCBV) compared to three of low-grade tumors. Hemangioblastomas, glioblastoma multiforme (GBM) and the primitive neuroectodermal tumor showed increased rCBV while pilocytic astrocytoma, ependymoma, and ganglioglioma showed decreased rCBV. There were no difference in fractional anisotropy (FA) values between tumor grades and types. Conclusion: Postcontrast T1-weighted image and perfusion MRI showed in this study to be very useful in differentiating high- and low-grade cystic tumors with the mural nodule. FA values added no benefit to tumor differentiation. Hemangioblastoma was the only tumor with increased rCBV among low-grade tumors. GBM, which is a malignant tumor, can present as a cystic lesion with a mural nodule.

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Background: Urinary schistosomiasis is one of the neglected tropical diseases. Of the 239 million people with active Schistosoma infections in 2009, 85% lived in sub-Saharan Africa. The urinary bladder is the main site of pathologic damage in patients with urinary schistosomiasis. Objectives: The objectives were to study the prevalence and pattern of sonographic bladder abnormalities in patients evaluated for urinary schistosomiasis. Materials and Methods: All consecutive patients being evaluated for urinary schistosomiasis at the Usmanu Danfodiyo University, Teaching Hospital Sokoto and Federal Medical Centre Birnin Kebbi were prospectively scanned at radiology departments of the two centers. All the patients were scanned with Apogee 800 plus (Japan 2002) and Concept D (Dynamic Imaging Scotland) ultrasound scanners with a variable frequency probes at 3.5–5 MHz. Doppler was used to assess the vascularity of urinary bladder masses, and to differentiate between masses and blood clots which is a diagnostic challenge when using brightness mode (B-mode) sonography alone. The gain was set correctly to allow good visualization of the bladder and adjacent structures. Transverse images are obtained in the true axial plane and angled caudal to show the bladder base. Longitudinal and oblique sagittal images are obtained to complete the examination. All the ultrasound findings and images were recorded as hard copies, and the films were reviewed by a qualified radiologist. The results were analyzed using statistical software SPSS 17.0 for windows. Results: We evaluated a total of 107 patients. The mean age of the patients was 42.9 ± standard deviation 16.8 years, with a range between 7 and 86 years. There were 84 males accounting for 78.5% and 23 females accounting for 21.5%. Abnormal sonographic findings were seen in 101 (94.4%) of patients evaluated. Urinary bladder stone with wall thickening was the most common finding accounting for 37 (36.4%), followed by bladder wall thickening with internal echoes accounting for 32 (21.5%) of the patients. The incidence of irregular bladder mass was 15 (14.0%) while polypoidal mass accounted for 4 (3.7%). Contracted bladder with wall calcification was seen in 7 (6.5%) while no abnormalities were seen in the urinary bladder in 6 (5.6%) of the patients. Conclusion: Abnormal bladder sonographic findings are common in patients evaluated for signs and symptoms of urinary schistosomiasis in North-Western Nigeria, with a prevalence of 94.4% in this current study. Urinary bladder stone with wall thickening followed by bladder wall thickening with internal echoes were the most common findings accounting for 58% of the findings. These sonographic abnormalities should raise the suspicion of urinary schistosomiasis in an endemic region.

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Background: Correct estimation of intravascular volume is crucial in critically ill and traumatized patients. Measurement of the central venous pressure (CVP) is invasive and time consuming. Studies have shown that inferior vena cava diameter (IVCD) correlates with CVP. Sonographic assessment of IVCD and its respirophasic changes (collapsibility index; CI) is a non-invasive, quick and reliable means of estimating CVP and hence, intravascular fluid volume. Data on such studies are scanty among adult Nigerians. Aim: To establish normograms of IVCD and CI for healthy adults in Benin City, Nigeria as well as determine the relationship of IVCD and CI with height, weight, body mass index (BMI), age and gender. Method: Four hundred apparently healthy adult volunteers were prospectively studied by means of ultrasound. Demographic data and BMI were obtained. The IVCD was measured during inspiration, expiration and sniff. The CI was subsequently calculated for each subject. Statistical Package for the Social Sciences (SPSS) version 17.0 was used for data analysis including tests of significance. Probability values less than or equal to 0.05 were considered significant. Results: The mean IVCD in this study was 6.1±2.2mm and 13.0±4.0 mm for inspiration and expiration respectively. The mean CI was 49.7±0.5%. There was no statistically significant correlation between IVCD and CI with height and BMI. Conclusion: This study has determined normal IVCD and CI reference range for healthy Nigerian adults. The CI is independent of height, weight, BMI and gender. Since the CI is not dependent on physical attributes and gender, it may serve as an objective tool for monitoring the fluid status of patient

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Background: Globally, 32.5 million people diagnosed with cancer within the 5 years previously were alive at the end of 2012. 8.2 million deaths and 14.1 million new cases are recorded annually, but 70% will be in developing countries. Lung, breast, and colorectal cancers are commonly diagnosed. Aim and Objectives: The aim and objectives of this study is to review the trend of cancer incidence in Lagos University Teaching Hospital (LUTH) from January 2004 to December 2013.Materials and Methods: This is a retrospective study of histologically confirmed malignancies seen at Radiotherapy Department, LUTH from January 2004 to December 2013. Case files were retrieved through the record department, and the information required was extracted with the aid of a data extraction form. Results: A total of 3,314 new cases of cancer were recorded in LUTH during the study period. The mean age of cancer presentation is 48.52 (±16.44). The median age is 49.00 years with an age range of 1–100 years. The peak age incidence for males was 50–54 years accounting for 10% of all male presentation while females had a peak age incidence of 40–44 years accounting for 14% of female cases. The male-to-female ratio was 1:3. Breast (38.1%), cervical (17.0%), and colorectal cancers (3.3%) are the common ones recorded. In males, the most common cancer was prostate cancer (12.8%) followed by colorectal cancer (4.5%). Conclusion: In general, cancer incidence in Nigeria appears low compared to developed countries which may not truly reflect the burden of the disease. This could be due to poor population-based statistics and poor health patronage of orthodox medical care.

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A 50-year-old patient who had acute severe asthma presented with avascular necrosis (AVN) of both femoral heads 6 months after short-term high-dose steroid therapy. The use of steroids on a long-term basis can cause AVN of the bone which also occurs in various diseases. A variety of traumatic and nontraumatic factors contribute to the etiology of AVN although long-term exogenous steroid administration and alcoholism are among the most common nontraumatic causes. AVN of both femoral heads presenting after short-term high-dose steroid treatment for acute severe asthma is rare in medical literature; thus, prompting the present case report.

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Multiple system atrophy (MSA) is a synucleinopathy, characterized by combined manifestations of cerebellar, parkinsonian, and autonomic features. It is subdivided into two main types-parkinsonian MSA (MSA-P) and cerebellar MSA (MSA-C). Magnetic resonance imaging (MRI) of the brain is a valuable tool in diagnosing this condition as it shows many characteristic features, such as the 'hot cross bun' sign. This is a cruciform hyperintensity imaging feature, seen at the level of pons in axial T2-weighted MRI images. This sign is typically seen in patients with MSA-C. This reported case describes a patient with MSA-C with characteristics brain MRI features.

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Background/Aim: Accurate classification of renal size as normal and abnormal depends on precise knowledge of acceptable normal range for the population. Ultrasound (US) is an excellent tool for defining the norm and imaging neonates suspected with renal pathology because it is cheap, easy to perform, and harmless. Since the kidneys of neonates are distinct from those of older children and there is a paucity of data on normal renal size in neonatal population in sub-Saharan Africa, this study is to determine the normal range of renal size in a large cohort of Nigerian neonates. Materials and Methods: In a cross-sectional study of 528 apparently healthy neonates from two large hospitals in Ibadan, Nigeria, clinical examination and renal US scans were performed in the first 28 days of life. Renal length and width were correlated with somatometric parameters and chronological age of neonates. Nomograms with point-wise 95% reference ranges were also constructed. Results: Mean renal length and width were 4.31 ± 0.50 and 2.03 ± 0.28 and 4.33 ± 0.52 and 2.01 ± 0.31 on the right and left, respectively. Only the mean renal lengths were significantly different between males and females (P < 0.01) and there was no significant difference between the renal dimensions by sidedness. Body weight, chronological age, and to a minor extent, length were found to correlate positively with all renal dimensions. Conclusions: This study of a large neonatal population has provided the normal range of US renal dimensions for neonates in the study area, using the age and weight in plotting the 95% reference ranges for the renal nomogram.

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