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   2013| July-December  | Volume 20 | Issue 2  
    Online since November 7, 2013

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Radiotherapy in Nigeria: Current status and future challenges
Kenneth Chima Nwankwo, David A Dawotola, Vinay Sharma
July-December 2013, 20(2):84-88
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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Classification of midfacial fractures on computed tomography following head injury in a Nigerian population
Yvonne U Osuagwu, Abiodun O Adeyinka, Atinuke M Agunloye, Vicky N Okoje
July-December 2013, 20(2):74-83
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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Avascular necrosis of both femoral heads following short-term high-dose steroid treatment for acute severe asthma - A rare presentation: Case report and review of literature
Philip Oluleke Ibinaiye, Abubakar Mohammed Musa, Samuel Olorunfemi David, Philip Chinedu Okere
July-December 2013, 20(2):104-106
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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Physiological periostitis: Reporting of a medical conundrum!
Subal Kumar Pradhan, Pawan Mutalik, Arakhita Swain
July-December 2013, 20(2):107-109
Physiological periostitis is a known, typically symmetric radiological finding in infants between 1 and 6 months of age. Traumatic periosteal new bone formation may be bilateral and one of the close differential diagnoses of physiological periostitis, but there is usually other evidence of fracture or trauma. Pediatricians and radiologists should be aware of this benign entity, so that unnecessary investigation and treatment may be avoided. We describe a two-months-old female child, who presented with swelling of both the legs and was confused with osteomyelitis initially, but later came to be diagnosed as physiological periostitis after ruling out other common diagnosis.
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Secondary lumbar spondylosis in University of Uyo Teaching Hospital, Uyo, Nigeria: Radiographic correlation with incidence and concomitant discovertebral pathologies
Felix Uduma Uduma, Dianabasi U Eduwem, Philip Chinedu Okere
July-December 2013, 20(2):96-100
Introduction: Lumbar spondylosis is an age-related degenerative disk disease of the lumbar spine. It could be preceded by known discovertebral lesions resulting in secondary lumbar spondylosis. Objectives: To determine the incidence of secondary lumbar spondylosis using lumbosacral radiographic evaluations. Study Designs/Settings: A cross-sectional prospective study. Radiology Department, University of Uyo teaching hospital, Uyo, Nigeria. Patient Sample: Two hundred and sixty-two patients. Outcome Measured: Pathologies are evaluated based on features seen on twin lumbosacral radiographs that demonstrate secondary spondylosis. Materials and Methods: Anterior-posterior and lateral plain radiographs of patients were done under standardized conditions. Studied period was 1 st May, 2011 to 12 th July, 2012. Results were analyzed using SSPS 13. computer package. Results: A total of 262 patients aged 10-89 years with mean age of 48.9 and standard deviation of 25.4 were studied. Males were 138 and females were 124. 173 patients constituting 66.03% of the studied population had lumbar spondylosis. A total of 57 patients (female to male ratio − 1.36:1) had secondary lumbar spondylosis. This constituites 32.95% of population with spondylosis. Secondary lumbar spondylosis was commonest in the 4 th to 6 th decade. A total of 17.54% of patients with secondary spondylosis were younger than 40 years. The commonest associated pathology was spondylolisthesis, n=25 cases (43.86%) with female predominance. The least were septic spondylitis and trauma (1.75% each). Other conditions were osteoporosis, metastasis, lumbarization, spina bifida, and Pott's disease. Conclusions: The commonest coexistence with lumbar spondylosis in Uyo, Nigeria is lumbar spondylolisthesis.
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Endovascular treatment of celiac artery aneurysm using detachable vascular plugs
Arun Gupta, Ajit Kumar Yadav, Hirenkumar Kamleshkumar Panwala, Abhishek Agarwal, Buxi TBS, KK Saxena
July-December 2013, 20(2):110-112
Aneurysm of the celiac trunk is one of the rarest forms of splanchnic artery aneurysm. Untreated lesions enlarge progressively and may rupture spontaneously. Treatment of the celiac artery aneurysm is usually done by surgery or percutaneously by coil embolization. Presented is a case of 85-year-old man who sought care for a celiac trunk aneurysm detected on Doppler examination and confirmed by computed tomographic angiography. Patient underwent successful embolization using detachable vascular plugs.
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The state of radiology subspecialty training in the west african subregion: The residents' perspective
Omolola Mojisola Atalabi, Ademola Joseph Adekanmi, Eniola Adetola Bamgboye
July-December 2013, 20(2):69-73
Background/Aim: Radiology residency was initiated nearly 30 years ago in the West African subregion, but accompanying formal subspecialty training has been developed within the 30 year time span. In contrast, subspecialization has evolved over the past 25 years in developed countries. The aim of this study was to determine residents' perspective about radiology subspecialization training in West Africa. Materials and Methods: Semi-structured, self-administered electronic questionnaires were sent to residents at different levels of training via E-mail and during update courses. Data analysis was performed using SPSS version 15.0 (IBM) package. Quantitative variables were expressed using summary statistics including means and medians. Descriptive analysis was performed for the qualitative variables using frequencies, proportions, and charts. Statistical significance was set at the 5% level using two tailed P values. Results: There were 117 respondents 85 (72.6%) males and 32 (27.4%) females. A total of 110 (94%) were aware of the various subspecialties in radiology with neuroradiology being identified by all as separate subspecialty. Interventional radiology topped the choice of subspecialty with 61 (52.1%) respondents, and 67 (57.3%) would prefer that subspecialties be introduced in phases. Ultrasound, basic X-ray, mamography equipment, and computed tomography scanners are available in many of the training centers. 116 (99.1%) of the residents believed that there is a need for subspecialization in the subregion. Conclusion: Our study demonstrates the need for subspecialization in West Africa. To achieve this goal, collaboration and support from well-established radiology residency and fellowship training programs based in developed countries is necessary.
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Clinicopathologic characterization of nasopharyngeal carcinoma seen in the radiotherapy and oncology department, ahmadu bello university teaching hospital, Zaria, Nigeria: 2006-2010
Sunday Adeyemi Adewuyi, Aminu M Usman, Modupeola OA Samaila, Aderemi T Ajeikigbe, Kingsley K Ketiku
July-December 2013, 20(2):89-95
Aims and Objective: To evaluate the clinical and pathological characteristics of nasopharyngeal carcinoma (NPC) patients seen in the Radiotherapy and Oncology department, Ahmadu Bello University Teaching Hospital, Nigeria. Materials and Methods: Between January 2006 and December 2010, 45 patients with histologically confirmed NPC were seen and evaluated irrespective of age, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Data were analyzed using Epi Info software and results presented in simple tables. Results: A total of 45 patients had NPC accounting for 2%. The mean age was 42 years (range 15-75 years). The sex ratio was M:F = 2.2:1. 21 of the patients were from North-West geopolitical zone. Hausa-Fulani was the predominant ethnic group in 23 patients. At presentation, 41 had neck mass followed by nasal blockage in 34, cranial nerve deficits in 27 and epistaxis in 25 (55.6%) patients. The commonest cranial nerves affected were vestibulocochlear 17, followed by glossopharyngeal 14. Only 14 patients presented within 12 months of onset of symptoms with a range of 3-60 months. The commonest histologic type seen was WHO-2 (Non-keratinizing Squamous Cell Carcinoma) in 28 patients. Locally advanced disease (IVA and IVB) seen in 25 patients and metastatic disease (IVC) seen in 13 patients. The site of metastases was the bones seen in 6 patients followed by lungs in 5 patients. Only 2 patients were positive for HIV antibodies. 38 patients were treated with chemotherapy and 18 received radiation therapy. Conclusion: Nasopharyngeal cancer is commoner in males. Neck mass with nasal and auditory symptoms were the commonest symptoms. More than half of the patients had cranial nerve deficits at presentation. WHO-2 is the commonest histology and locally advanced and metastatic disease is the commonest stage at presentation.
  5,035 17 -
Unusual age at presentation of klippel-trenaunay syndrome
Sanjeev Singhal, Nidhi Soni
July-December 2013, 20(2):101-103
Klippel-Trenaunay (KT) syndrome is a congenital vascular disorder which is rare and affects one or both limbs. It has incidence of about 2-5 in 100,000. French physicians Klippel and Trenaunay first described this syndrome in the year 1900. They named the syndrome as "nevus vasculosus osteohypertrophicus". In 1907, Park Weber named the same condition hemangiectatic hypertrophy. The etiology is unknown. Though it is a sporadic condition, paradominant inheritance pattern has also been suggested. Patients generally present in the first decade of life. It affects males more than females. KT syndrome is a congenital circulatory disorder typically comprising of the triad cutaneous capillary angioma, bone and soft tissue hypertrophy and varicose veins. There are several theories about its pathogenesis. The management of this syndrome consists mainly of early diagnosis, prevention and treatment of complications. We report the case of a 30-year-old male patient with KT syndrome showing the classical triad.
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