Ultrasound in the diagnosis of appendicitis: a plea for caution

Background/Objectives: Acute appendicitis is one of the most frequent causes of acute abdomen. The clinical diagnosis is based on the case history and the physical examination. However, in some cases the typical clinical symptoms are equivocal or misleading at which time, making the diagnosis of appendicitis may be considerably difficult. Ultrasound may play a role in this class of patients. This article assesses the accuracy of this adjunctive test at our centreMethods: This is a six-year retrospective study from July 2000 to July 2005 looking at patients that had appendicectomy done at Ahmadu Bello University Teaching Hospital Kaduna Nigeria. We analyzed postoperatively those with histological diagnosis of appendicitis who at the same time had preoperative ultrasound assessment for the main purpose of establishing appendicitis. The final histopathological evaluation was used as the standard to rate the efficacy of ultrasonographic diagnosis of appendicitis.Results: One hundred and forty nine patients 149 were documented. 128 had adequate data for further analysis and only. 78patients (60%) had ultrasound before surgery. The actual diagnostic accuracy of ultrasound in our environment is 24.4%.Conclusions: Ultrasonography routine use in all our patients suspected of having classical appendicitis cannot be advocated at present

Pattern of skeletal metastases from breast cancer in an Asian population

Objectives:: To evaluate the pattern of skeletal metastases from breast carcinoma in an Asian population. To study the radiological pattern and distribution of bone metastases from breast cancer .Background: Breast cancer is a disease that is prevalent world wide and frequently metastasis to the bones . Bone metastasis is associated with increase morbidity and poor quality of life in breast cancer patients. Prompt identification and treatment is the best way of improving the patients’ quality of life. Skeletal x-rays and bones scan of relevant bones should be part of staging investigations and metastatic survey in breast cancer.Methods: This study was prospective, non-randomized, and single institution based. A total of 30 consecutive patients having bone pains with radiological evidence of bone metastases were included. Questionnaire was designed for the collection of patients’ data for evaluation, which was then entered on database and analyzed on the Statistical Package for Social Sciences (SPSS). Patient were staged using TNM Classification.Results: The radiological pattern was Osteolytic in (28) 93.3% and mixed pattern (osteolytic & osteoblastic) in (2)6.7%. The commonest site of bone metastases was Lumbar spine (51.5%) followed by the Thoracic spine (21.6%). There was involvement of multiple, non-contiguous skeletal bones in(7)23.3% of the patients. Majority of the patients were stage III (56.6%) at first presentation. At presentation (6) 20% had painful bone metastases and 16.7% developed painful bone metastases within 12 months, 30.0% from 12 to 24 months, and 33.3% after 24 months of diagnosing breast cancer. 20.0% of patients had painful bone metastases for < 3 months prior to local field irradiation (LFI); 46.7% had pain for 4 – 6 months; 6.7% had pain for 7 – 9 months; 10.0% had pain for 10 – 12 months; and 16.7% had pain for more than 12 months prior to treatment with LFI.Conclusion: The predominant x-ray finding in bone metastases from breast cancer was osteolytic and the Lumbar spine was the commonest site of involvement . Involvement of Multiple bones in 25% of the patients suggest widespread search in a staging protocol

Sheehan's Syndrome; A Rare Complication of Postpartum Hemorrhage - Case Report and Review of the Literature

Sheehan Syndrome is a Condition that may occur in a woman who bleeds severely during child birth. Severe bleeding during child birth can cause tissue death in the pituitary gland, which may cause the +0 gland to lose its ability to function properly. We reported a case of a 21 year old lady gravida 1 para 1 (alive) who developed Sheehan's syndrome six months after extreme post partum hemorrhage. High level of suspicious was employed based on clinical history and couple with the laboratory blood tests and magnetic resonance Imaging (MRI) findings in arriving at diagnosis of this rare complication of lifethreatening blood loss during or after child birth. We also highlighted the importance of proper medical care in preventing extreme bleeding during child birth, otherwise, Sheehan's syndrome is not preventable.Keywords: Sheehan's Syndrome, Post Partum Hemorrhag

TREATMENT OF CRANIOFACIAL DEFICITS ASSOCIATED WITH DOWN SYN-DROME IN A MOUSE MODEL

poster abstractTrisomy 21 is the genetic source of the group of phenotypes commonly known as Down syndrome (DS). These phenotypes include cognitive im-pairment, heart defects and craniofacial abnormalities, including a small mandible. The Ts65Dn mouse model contains three copies of approximately half the genes found on human chromosome 21 and exhibits similar pheno-types to individuals with DS including a small, dysmorphic mandible. Our lab has traced this deficit to a smaller first branchial arch (BA1) consisting of fewer neural crest cells (NCCs) at embryonic day 9.5 (E9.5). At E9.5, Dyrk1a, a gene known to affect craniofacial development, is upregulated in the BA1, likely contributing to its cell deficit. Using epigallocatechin gallate (EGCG), an extract from green tea and a known inhibitor of Dyrk1a, we are attempting to rescue this deficit. We hypothesize the consumption of EGCG by pregnant mothers at E7 and E8 will rescue the mandibular deficit in de-veloping embryos by reducing the expression or activity of Dyrk1a. From our data we conclude the treatment of pregnant mothers with EGCG results in increased embryo size of trisomic embryos. Further analysis will be done to determine embryo volume, the volume of the BA1, and number of NCCs within the BA1 to determine the effects of EGCG in vivo. This research will better our understanding of craniofacial development and could lead to po-tential genetic-based therapies in the future

Analysis of Indoor Thermal Comfort Perception of Building Occupants in Jimeta, Nigeria

The study examined the perception of occupants on thermal comfort in Jimeta, Nigeria where the temperature is high, hot and dry weather. The objectives are to assess factors impacting on indoor thermal comfort, and effect of ventilation on heath of occupants in the area. Indoor thermal comfort and room temperature survey of thirty occupants’ living rooms were taken using thermometers. Results show that building forms and orientation, building openings to floor area ratio, landscaping, and building fenestration have direct effect on the average room temperature of residential buildings. Challenges of high temperature, insomnia, fatigue, boredom, headache, poor arousal, and asthma are among health implications of inadequate ventilation suffered by occupants. It is recommended that building professionals be engaged in planning, design and construction of buildings to aid the application of building orientation, ratio of building openings to floor area, and landscaping among others to achieve ventilation and comfortable temperature. Keywords: Buildings, Hazards, Temperature, Thermal comfort, Ventilatio

Histiocytosis X

Histiocytosis X (Langerhan’s cell granulomatosis) is a disease of unknown aetiology, but viral origin has been implicated.1 It is a clinicopathologic entitycharacterized by proliferation of Langerhan’s cell (which are not primarily phagocytic) in an appropriate milieu.

Congenital bilateral fusion of the maxillomandibular alveolar processes with craniosynostosis: report ofa rare case

A rare congenital anomaly of maxillomandibular fusion with pectus excavatum and craniosynostosis in a neonate is presented. The child was kept alive by nasogastric tube feeding.Amodification of classification of syngnathia is proposed. The aetiopathogenesis and difficulty in management in our environment are discussed. Keywords: Bilateral; alveolar fusion; craniosynostosis; pectus excavatum Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.78-8

Purpura Fulminans with Disseminated Intravascular Coagulopathy and Symmetric Peripheral Gangrene Complicating Sepsis in an Infant: A Case Report

Purpura fulminans is a rare consequence of sepsis that could be complicated by DIC and gangrene. We report the case of a 2-months-old infant who developed gangrenous limbs. He presented with fever, diarrhoea, vomiting and irritability for 5 days and was dehydrated and unconscious with global hypertonia. With a clinical impression of sepsis antibiotics, IV fluids and supportive care were commenced. He developed purpuric rashes over the trunk and feet, the latter of which gradually ascended over the legs, with swellings and ischemic skin changes up to the knees. A diagnosis of purpura fulminans was made and further evaluation revealed deranged haematologic parameters, features of Disseminated Intravascular Coagulopathy (DIC), hypernatraemia, azotaemia and arterial occlusion. Despite blood transfusions and supportive care gangrene emerged and progressively ascended towards the knees. Parents however rejected offer for surgical amputation and left against medical advice. The coexistence of purpura fulminans with multiple triggers for DIC should alert clinicians of a potential risk of peripheral gangrene.Keywords: Infant, Sepsis, Purpura fulminans, DIC, Gangren

Neurobrucellosis- A Case Report and Review of Literature

Neurobrucellosis is a rare form of systemic brucellosis, a disease acquired through ingestion of unpasteurized dairy products, which may manifest as stroke, encephalitis, meningitis, or psychiatric disorders. Presently there is no known report of neurobrucellosis in Nigeria, although consumption of unpasteurized dairy products is not uncommon in this country. In this report we present a 28 year old spinster with history of significant ingestion of unpasteurized cow milk and brucellosis of the brain diagnosed in our centre through brain magnetic resonance imagining (MRI) and brucella antigen agglutination test. Because of the indolent nature of brucellosis infection, it should be suspected in individuals with pyrexia of unknown origin so that early detection and treatment could prevent long-term sequelae such as focal neurologic deficits, hydrocephalus and psychiatric illness.Key Words: Antigen agglutination test, Brucella, neurobrucellosis, unpasteurized dairy product