Management and Outcome of Peyronie's Disease in Nigeria- Initial Experience

Peyronie's disease is characterized by the formation of fibrous plaques within the tunica albuginea of the corpora cavernosa. It is a frustrating disease to the patient resulting in penile deformity and painful erection and erectile dysfunction. There is mixed response to medical therapy and the numerous surgical options implies no standardized procedure yet. The incidence appears to be increasing but this disease is rarely reported in Nigeria. We present three cases of dorsal and ventral Peyronie's disease treated and followed up for 2years who responded to surgical and medical treatment with satisfactory sexual life and penile erection.Key Words: Peyronie's disease, management, Nigeri

Do Abnormal Findings on Hystero-Salphingographic Examination Correlate with Intensity of Procedure Associated Pain?

The aim of this study is to determine if the intensity and nature of pain during Hystero-Salphingography could give a clue to the presence of abnormal finding/s. Eighty-two patients were recruited over a six-month period. Procedural pain was assessed using the numeric rating scale. Mean age was 33.2 ± 4.9 years. The median pain score in patients with normal findings was 6.0 but7.0, 8.0, and 8.5 in those with right tubal blockade, uterine fibroids and left tubal blockade respectively. No statistical difference in the absolute pain score between patients with normal and abnormal findings. Pain scores in patients with 1 and 2 abnormalities were 7.0 and 7.5, and the number of abnormalities did not affect pain score (P = 0.3). The presence or absence of pain during HSG may not be a suitable way of determining the presence or absence of abnormal HSG finding/s. .Afr J Reprod Health 2014; 18[2]: 147-151).Keywords: Hystero-salphingography; abnormal findings; Pain. Le but de cette étude est de déterminer si l'intensité et la nature de la douleur pendant l’hystérosalpingographie pourraient donner une indication de la présence des constatation(s) anormale(s). Quatre-vingt deux patients ont été recrutés au cours d’une période de six mois. La douleur de la procédure a été évaluée en utilisant l'échelle d'évaluation numérique. L'âge moyen était de 33,2 ± 4,9 ans. Le score de douleur médiane chez les patients qui présentaient des résultats normaux était de 6,0 but7.0, 8,0, et 8,5 chez ceux qui présentaient des blocages des trompes droites, les fibromes utérins et des blocages des trompes gauches respectivement. Il n’y avait aucune différence statistique du score de douleur absolue entre les patients avec des résultats normaux et anormaux. Les scores de douleur chez les patients avec 1 et 2 anomalies étaient de 7,0 et 7,5, respectivement et le nombre d'anomalies n'ont pas de conséquence sur le score de douleur (p = 0,3). La présence ou l'absence de douleur pendant la HSG peut ne pas être un moyen approprié de déterminer la présence ou l'absence des constatations anormales de la HSG. Afr J Reprod Health 2014; 18[2]: 147-151).Mots-clés : hystérosalpingographie, résultats anormaux, douleur

Pattern of asymptomatic sexually transmitted infections in women undergoing hysterosalpingography for infertility evaluation in Ibadan Nigeria.

The roles of gonorrhea and non-gonococcal urethritis due to Chlamydia trachomatis in the etiology of infertility due to tubal occlusion have been established by various studies. Hysterosalphingography (HSG) is done to investigate tubal patency. This study was aimed at finding the prevalence of asymptomatic sexually transmitted infections (STIs) in women being investigated for infertility in a tertiary institution.Methods: This was a cross-sectional study of asymptomatic infertile women referred for pre-HSG screening. Detailed medical history, Endocervical and high vaginal swabs were collected to establish diagnosis of STIs following clinical examination and informed consent. These specimens were evaluated microscopically for Chlamydia trachomatis and bacterial vaginosis. Endocervical secretions were Gram-stained for intracellular Gram – Negative diplococci and suspected isolates were confirmed as Neisseria gonorrhoeae by standard laboratory methods.Results: There were 250 participants with a mean age of 34.6 years (SD = 5.4, range = 25 -49). The mean age of sexual debut of participants was 21.5 years (SD = 4.3). Fifty-six (22.5%) of the women engaged in oral sex while 53 (21.2 %) shared their spouses with other sexual partners. 17.7% had previous PID, 43.1% of them has vaginal discharge syndrome. The commonest STI was Vulvo- vaginal candidiasis (24.4%) and others were bacterial vaginosis (18.4%), Chlamydia cervicitis ( 17.6% ), trichomoniasis (11.2% ), and gonorrhea ( 2.4 % ).Conclusion: The procedure of HSG is invasive and asymptomatic infections in the cervix can be dislodged and propagated by injection of contrast to the fallopian tubes thus causing tubal blockage. Routine Pre-HSG screening for occult STIs is encouraged to avoid iatrogenic Pelvic Inflammatory Disease.Keywords: Hysterosalpingography, Sexually Transmitted Infections, Infertility

The Yield from Routine Chest X-Rays in Stage 3 Breast Cancer Patients

Context: Cancer of the breast is a common malignancy in Nigerian women and various imaging examinations, including the chest radiograph are routinely requested in all patients with this disease.Objective: The objective of this study was to determine the positive yield from routine chest radiographs in Nigerian patients with locally advanced stage 3 breast cancers but who had no clinical symptoms or signs of pulmonary or pleural metastatic disease. Methods: This descriptive retrospective study evaluated clinical records and chest radiographs of 61 female Nigerian patients with local stage 3 histologically diagnosed breast cancers, who presented at the radiotherapy unit of the University College hospital, Ibadan, over a 12-month period. Allabnormalities on the chest radiographs were documented.Results: The ages of the study group ranged from 25 to 67 years with a mean of 47years. Fortyseven (77%) of the patients had normal chest radiographs. Of the 14 abnormal radiographs, bilateral lung parenchymal metastases were seen in 4 cases one of whom also had bilateralpleural effusion. Other abnormal findings included hilar adenopathy, right lower lobe collapse, lymphagitis carcinomatosis and cardiomegaly.Conclusion: The authors conclude that a 23% detection rate from these screening chest radiographs is high and should be recommended as over 70% of Nigerian Patients with breast cancers present with advanced tumors

Malignant haemangiopericytoma of the left thigh with metastases to the bones and lungs: A case report

Haemangiopericytoma is an uncommon mesenchymal neoplasm. Haemangiopericytoma is believed to arise from the pericytes, contractile spindle cells that surround the capillaries and post-capillary venules. We present an unusual case of histologically confirmed malignant haemangiopericytoma of the left thigh in a 70 year old male with metastasis to the lungs and left femoral bone

Misconception about ultrasound among Nigerian women attending specialist and tertiary health institutions in Ibadan

Background: In women health, ultrasound is well established as a safe tool, and it is often the first imaging modality employed in the, screening, investigation and treatment of conditions in obstetrics and gynaecology. However, women's misconceptions about health issues, aetiology and treatment of diseases conditions may have negative impact on their health care seeking behaviour. Client's perspective of diagnosis including investigation process is therefore crucial in health care. This study aimed at finding out the misconceptions expressed by clients about ultrasound, and the potential predictors associated with this attitude among women in Nigeria.Method: A descriptive cross-sectional survey was conducted among 3137 women who presented for transabdominal ultrasound scan between August and November 2010 in two referral hospitals in Nigeria. Data were obtained using a questionnaire. Descriptive and multivariate analysis was performed applying logistic regression analysis; predictors of misconceptions  expressed by clients about ultrasound, and misconceptions among women in Nigeria were identified using SPSS Statistics (SPSS Inc, Chicago, IL) version 17 software.Results: The mean age of the women was 33.8 years (standard deviation = 7.9), with 88.8% currently married. More than half of the responders had tertiary education (56.6%), followed by secondary school education  (34.5%), primary education (7.8%) and no formal education (1.1%). There were 59 women who held the misconception that ultrasound was dangerous to health accounting for 1.9% of the study population. The reasons given by this group of women Included; 'ultrasound can kill or destroys the body cells' (35.6%); it can cause cancer (15.3%); 'the radiation is only dangerous to some organs of the body' (6.8%); it can harm or deform the fetus (6.7%); it is only dangerous when exposure is frequent (5.1%); and only dangerous when handled by unskilled medical personnel (1.7%).Conclusion: This study provides insight to the wide range of issues about clients' perception and misconception regarding ultrasound safety. These issues have to be addressed to improve better compliance and patronage about ultrasound scans in Nigeria. We suggest that robust counseling session is imperative to address all the views and possible concerns of clients to improve better service delivery

X-Ray Hysterosalphingography: The Most Painful Part in the Nigerian Woman.

Background: Hysterosalphingography (HSG) despite the accompanying pain still remains relevant in gynaecological practice. For effective analgesia, it is important to identify the most painful step of this procedure. Numerical Rating Scale (NRS) and the Categorical Pain Scale (CPS) were used to identify the most painful step of HSG procedure and to find out if age, parity and the degree of infertility affect pain perception in this group of patients. Patients and Methodology: Ninety Four women referred for HSG due to infertility were recruited into this study. Their background pain and perceived pain of each step of the procedure was graded using the NRS and the CPS. The data collected were statistically analysed. Results: Participant’s age ranged from 21 to 34 years with a mean of 33.3±4.8 years. Cervical traction with introduction of cannula and instillation of contrast was found to be the most painful step of the procedure both having a median score of 6 (range 0-10) based on the NRS and were rated to be moderate to worst possible pain based on the CPS. Almost 65% of the patients perceived the pain to be more than expected and nearly 100% would have preferred one form of analgesia or the other. Conclusion: The most painful step of HSG was found to be the same for the Nigerian women as in other parts of the world. These women should be offered effective analgesia for pain during HSG procedure. Key words: Hysterosalphingography, Pain Rating, Painful Ste

Cranial Computerized Tomography In The Evaluation Of Stroke Patients In Ibadan

206 patients clinically diagnosed as stroke / cerebrovascular accidents (CVA) were investigated using computerized tomography (CT) scan. 19 patients (9%) had normal scan. While 20(9.7%) had other lesions including atrophy and tumours. Of the 167 (18. %) patients proven to have suffered a cerebro- vascular accident (CVA/stroke), 73 (43.7 %) were haemorrhagic , 92 (55.1%) were infarcts; and left side when it is haemorrhagic than infarct (16.7% :38.3) The parietal and frontal lobes were affected when lesions occur in single site while caudate nucleus, putamen and ventricle are commonly affected when lesion is more than 2 sites. The occipital lobe i.e. posterior artery territory is infrequently involved. KEY WORDS: Cranial, Computerized Tomography, Stroke. Nigerian Journal of Clinical Practice Vol.6(2) 2003: 81-8

Transvaginal ultrasonography: a survey of the acceptability and its predictors among a native African women population

Omolola M Atalabi1, Imran O Morhason-Bello2, Ademola J Adekanmi1, Anthony O Marinho3, Babatunde O Adedokun4, Adegoke O Kalejaiye3, Kayode Sogo3, Sikiru A Gbadamosi31Department of Radiology; 2Department of Obstetrics and Gynaecology, College of Medicine/University College Hospital, University of Ibadan, Ibadan; 3St Gregory's Specialist Clinic and Ultrasound Diagnostic Centre, Yemetu, Ibadan; 4Department of Epidemiology, Medical Statistics, and Environmental Health, College of Medicine, Ibadan, NigeriaObjective: To determine the acceptability of transvaginal ultrasonography (TVU) and associated factors among Nigerian women.Method: A cross-sectional survey was conducted among 3137 women who presented for transabdominal ultrasound scan between August and November 2010 in two referral hospitals in Nigeria. Data were obtained using a questionnaire. Descriptive and multivariate analysis was performed applying logistic regression analysis; predictors of willingness of participants regarding transvaginal ultrasound were identified using SPSS Statistics (SPSS Inc, Chicago, IL) version 17 software.Results: The mean age of the women was 33.8 years (standard deviation = 7.9), with 88.8% currently married. About 84% were willing to have TVU, while 54.2% were indifferent about the gender of the sonologist. About 17.3% believed that the procedure is painful. Significant predictors of willingness to have TVU were previous sexual experience and douching, prior painful vaginal examination, and vaginal surgery.Conclusion: The majority of Nigerian women expressed a willingness to have the TVU procedure without necessarily opting for any gender preference of the operator. Women should be adequately counseled on the operations of the procedure so as to be able to psychologically prepare for them.Keywords: transvaginal ultrasound, willingness, Nigeria, Afric