30 research outputs found
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Gender and Age Differences in Cardiac Size Parameters of Ghanaian Adults: Can One Parameter Fit All? Part Two
Background: The cardiothoracic ratio (CTR) is a radiographic parameter commonly used in assessing the size of the heart. This study evaluated the gender and age-based differences in the average cardiothoracic ratios, and transverse cardiac diameters (TCD) of adults in Ghana.
Method: Plain chest radiography reports of 2004 patients (without known chest related diseases) generated by two radiologists with at least 15 years' experience from July 2016 to June 2020 were retrospectively analyzed for this study. The CTR for each radiograph was calculated using the formula CTR=(TCD÷TTD)×100, where TCD and TTD represent transverse cardiac diameters and transverse thoracic diameters, respectively. Data were analyzed with the statistical package for social sciences version 23. The independent t-test and One-way Analysis of Variance tests were used in the analyses.
Results: A total of 2004 patients' chest x-rays were used in the analyses. The ages of the patients ranged from 20-86 years old with a mean of 39.4±14.04 years. The mean CTR for males was 46.6 ± 3.7% while that of females was 47.7±3.7%. The difference in the overall CTR among the gender groupings was statistically significant (p = 0.001). There were statistically significant differences between the gender categories among patients in the following age groups: 30-39 (p=0.046), 40-49 (p=0.001), 50-59 (p=0.001) and 60-69 (p=0.001).
Conclusion: The study reveals there are significant gender and age-related differences in cardiac size parameters obtained from routine, frontal chest radiographs. These differences, if considered, may result in early and appropriate treatment of cardiac pathology in some age groups
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Percutaneous transhepatic biliary stent placement in the palliative management of malignant obstructive jaundice: initial experience in a tertiary center in Ghana
INTRODUCTION: one of the mainstays of management of malignant biliary obstruction is the decompression of the biliary system and its associated obstructive symptoms. Non-surgical palliative treatment such as percutaneous transhepatic biliary stenting is desirable in many selected patients. However, this service is often not available in many resource-limited countries. We share our initial experience of percutaneous transhepatic biliary stenting for the management of malignant biliary obstruction in our first set of patients with surgically non resectable malignant biliary obstruction in Ghana.
METHODS: percutaneous transhepatic biliary stenting was performed on the first 23 consecutive patients at the Korle Bu Teaching Hospital. The procedure served as the first palliation for malignant obstruction through interventional radiology. Medical records as well as serum levels of total bilirubin (TBil), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were used to assess the efficiency of the intervention. Microsoft Excel 2010 was used to analysis the data. RESULTS: most patients had resolution of jaundice with marked improvement in liver function and resolution of the itching associated with obstructive jaundice. During the follow-up of cases, one major complication of hemoperitoneum occurred requiring laparotomy. No other major complications such as bile leakage or death occurred. Four (4) patients had sepsis, which was managed.
CONCLUSION: the introduction of the intervention in Ghana has proven to valuable for palliative drainage and relief of obstructive symptoms, hence contributing to better patient management. It is relatively safe with minor complications among Ghanaians with non-resectable obstructive symptoms
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Complicated left isolated internal iliac artery aneurysm (IIIAA) in a young man - An unusual presentation in a Tertiary Hospital in Ghana: Case report
Generally, an aneurysm is a disease of the elderly due to the degenerative aetiological factor. Isolated internal iliac artery aneurysm (IIIAA) is rare, representing 0.3–0.5 % of all intra-abdominal aneurysms. It is a focal dilatation of the internal iliac artery alone with a threshold for surgical intervention set at 8 mm. Herein, we present an unusual presentation of a rare condition of a huge left internal iliac artery aneurysm in a young man with no identifiable risk factor complicated by left ilio-femoral deep vein thrombosis. Even though this is an interesting case study, the lack of facilities to do anaerobic cultures remains a major limitation in our setting
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Intracranial stents in the management of wide-neck intracranial aneurysms
Intracranial aneurysms are bulges in vessels that are prone to rupture with attendant morbidity and mortality. Early detection and treatment can avoid rupture and its associated consequences. Endovascular treatment of aneurysms with wide neck can be challenging due to potential coil migration or protrusion. The use of intracranial stents and balloons can help overcome some of these management challenges. We present 3 cases of endovascular treatment of wide-neck intracranial aneurysms. The first patient presented with a wide-neck left middle cerebral artery aneurysm that was successfully treated with stent-assisted coiling with complete obliteration of the aneurysmal sac. The second patient presented with a large, cavernous internal carotid artery aneurysm that was successfully treated with a flow diverter stent with complete obliteration of the aneurysm while the third case presented with a wide-neck left posterior communicating artery aneurysm and was also successfully treated with stent-assisted coiling. Even though endovascular treatment of wide-neck intracranial aneurysms is technically challenging, the evolution of new treatment techniques such as the use of stents and stent-assisted coiling make these treatments safe
Ultrasound diagnosis of acrania with major low–lying placenta and polyhydramnios; case report
Acrania is a rare foetal anomaly in which the calvaria is absent, and the meninges come into direct contact with the amniotic fluid. Acrania is the most common anomaly in the acrania – exencephaly – anencephaly spectrum, with anincidence of 3.68 to 5.4 per 10,000 live births. We present a case of a primigravida who presented for an ultrasound on account of vaginal bleeding in early cyesis. Transabdominal ultrasound showed a viable foetus at 13 weeks without a calvaria, with the brain in direct contact with amniotic fluid. There was a low-lying placenta extending from the posterior to anterior part of the lower uterine segment, completely covering the internal cervical os (major low–lying placenta), a placental cyst and polyhydramnios (amniotic fluid index, AFI of 17 cm). A diagnosis of acrania with major low–lying placenta and polyhydramnios was made. Detailed ultrasound is required to detect acrania at 13 weeks. The diagnosis of acrania is required to help direct patient counselling and maternal expectation. When acrania and major low–lying placenta occur in the same patient, both diagnoses must be promptly made concurrently, regardless of gestational age and without waiting for placental trophotropism and migration to occur first
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Intracranial aneurysms in Ghanaian adults
Objective: To document the location, size, and multiplicity of intracranial aneurysms in Ghanaians who have un-dergone digital subtraction angiography (DSA) at a single centre in Accra, Ghana.
Design: We conducted a retrospective observational review of the medical records of all patients diagnosed with intracranial aneurysms on DSA
Setting: Patients' medical records at Euracare Advanced Diagnostic and Heart Centre were reviewed between March 2018 and March 2020. Participants: Thirty-one patients were identified with various intracranial aneurysms (IAs) within the study period. Patients' ages, sex, and types of IAs were extracted using a checklist and analysed using Microsoft Excel for Win-dows 2016.
Interventions: None
Main outcome measures: The prevalence of types and distribution of intracranial aneurysms.
Results: The age range of the patients was 26-76 years, with a mean age of 45.5±14.3 years. The mean age of men and women with IA was 45.5 ±15.9 years and 46.7 51.3±12.9 years, respectively. The most common IAs were located in the posterior communicating artery (PCOM) at 54.8% (95%CI: 36.0, 72.7), followed by the anterior communicating (ACOM), which constituted 32.3% (95%CI: 16.7, 51.4). The majority, 89.2% (33/37) of these aneurysms were less than 7mm in diameter. Single aneurysms were present in 25 (80.6%).
Conclusion: The most common IAs were found in the PCOM and ACOM, and IAs tend to rupture at a younger age and smaller size among the Ghanaian adults examined. Early detection and treatment of IAs less than 7mm in diameter is recommended
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Contrast Medium Use in Computed Tomography for Patients Presenting with Headache: 4-year Retrospective Two-Center Study in Central and Western Regions of Ghana
BACKGROUND: Contrast medium (CM) administration during computed tomography (CT) enhances the accuracy in the detection and interpretation of abnormalities. Evidence from literature also validate the essence of CM in imaging studies. CT, by virtue of its ubiquity, ease of use, speed, and lower financial footprint, is usually the first investigation in cases of headache. Through a multicenter retrospective analysis, we compared findings of contrast-enhanced CT (CECT) to noncontrast-enhanced CT (NCECT) head examinations among patients presenting with headache.
METHODS: A multicenter retrospective analysis of four years' CT head examination data at two radiology centers located in Central and Western Regions of Ghana were reviewed. Records of patients who presented with headache as principal complaint between January 2017 and December 2020 were reviewed. A total of 477 records of patients with headache were identified, retrieved and evaluated. A Chi-square test and Fisher exact test were used to compare the CECT and NCECT groups. Binary logistic regression analysis was computed to assess association between CECT and each CT findings. Statistical significance was considered at p < 0.05 with a 95% confidence interval.
RESULTS: A significant proportion of the patients was females (51.8% in CECT and 60% in NCECT). The NCECT group (40.06 ± 14.76 years) was relatively older than the CECT group (38.43 ± 17.64 years). There was a significant difference between the CECT and NCECT in terms of age (p=0.002) and facility CT was performed (p < 0.0001). The rate of abnormalities was higher in CECT (43.5%, 166/382) compared NCECT (37.9%, 36/95). There was no significant association between CT head findings and contrast enhancement.
CONCLUSION: CECT examination accounted for 5.6% increase in the detection of head abnormalities. Efforts required to establish local standard operation procedures (SOPs) for contrast medium use especially in CT head examinations. Further studies to improve the knowledge of agents, mechanism of action, and safety of contrast media used among practitioners in Ghana is recommended
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Correlation of sonographically-determined residual urine volume with lower urinary tract symptoms in adult males at a tertiary hospital
Objective: To determine the correlation between the severity of LUTS as measured by the International Prostate Symptom Score (IPSS) and PVR urine volume measured by transabdominal ultrasound in patients with LUTS, and to determine the correlation between ‘feeling of incomplete bladder emptying and sonographically measured PVR urine volume.
Design: Correlational cross-sectional study Setting: Ultrasound Unit of the Radiology Department and Urology Clinic of Korle Bu Teaching Hospital Participants: Male patients (n=256) aged 40 years or more and who presented to the urology department of Korle Bu Teaching Hospital with LUTS and gave their written consent were enrolled. The presence and severity of LUTS were evaluated using the IPSS. The PVR urine was measured using real-time transabdominal ultrasound scan.
Main outcome measure: Severity of LUTS and Residual urine volume Results: The mean PVR urine volume was 84.5ml. Majority of respondents (57.3%, n=146) had PVR urine volume below 50ml with 27% (70 patients) having PVR urine volume above 100ml. PVR urine volume and total IPSS showed no statistically significant correlation. All age groups of respondents scored above 4 for quality of life (QoL). ‘Intermittency’ is the IPSS symptom which showed statistically significant correlation with PVR urine volume. PVR urine volume did not show a statistically significant correlation with the ‘feeling of incomplete emptying’.
Conclusions: There was no statistically significant correlation between the total IPSS and PVR urine volume, thus residual urine volume does not correlate with severity of LUTS. The ‘feeling of incomplete emptying’ does not correlate with PVR urine volume
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The spectrum of computed tomography calcium scoring values of individuals testing for coronary artery disease in Accra: a study from a peripheral private clinic in Southern Ghana
Background: Coronary artery disease is a significant cause of morbidity and mortality globally. Most people with coronary artery disease are asymptomatic, making its early detection with coronary artery calcium scoring using multidetector computed tomography an important aspect of its management.
Objective: Our study aimed to describe the spectrum of computed tomography findings (such as the absolute coronary artery calcium scores and coronary artery risk percentiles) and associated risk factors of 325 patients evaluated for coronary artery disease in Accra.
Methods: The study was a retrospective study involving retrieving electronically stored coronary artery calcium score reports for 325 patients reported by two radiologists. The patients had been referred for coronary artery calcium scoring from January 2020 to December 2021. Data were analysed using Statistical Package for the Social Sciences version 23.
Results: There were 62.2% (n = 202) males and 37.8% ( n = 123) females. Of the total number, 44.6% (n = 145) had a normal coronary artery calcium score of 0, while 55.4% (n = 180) had values ranging from 1 to 2,690 (mean 109.0 ± 325.4). The most prevalent modifiable risk factor for coronary artery disease recorded for individuals with coronary artery calcium score above 0 was an abnormality of weight (overweight and obesity). A significant relationship was observed between coronary artery calcium scoring and age (p = 0.001).
Conclusion: Our study showed that more than half of the participants had coronary artery calcification; abnormalities of weight followed by hypertension were the two commonest risk factors for CAD in Accra, and CAD occurred in individuals as young as 30 to 39 years old
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Imaging patterns of the arterial supply of the prostate gland in adult Ghanaian men
Background
Prostatic arterial embolization (PAE) is a novel procedure in West Africa and Ghana. A thorough understanding of the prostate artery's (PA) anatomy and pattern is required for successful prostatic arterial embolization and to guarantee targeted intervention. This study focuses on prostate arterial supply in adult males, including prevalence, variability, and imaging pattern.
Methodology
A prospective cross-sectional study was conducted, at Euracare Advanced Diagnostics and Heart Centre. Patients who presented for Computed Tomography Angiography of the pelvis were included in the study. A total of 52 males were included and 104 pelvic CT angiography (one for each side) were analyzed, including: prostatic artery diameter, prostatic gland volume and prostate artery branching pattern. The PA branching pattern was classified using de Assis et al. classification.
Result
Thirty-seven (71.15%) men had enlarged prostate volume (>30ml). On each side there was only one prostatic artery and no accessory one was found. Only three types of arterial branching were identified: type I, II,III. The type I artery was the most common origin 58.7% (61/104). PA originating from the anterior division of the internal iliac artery (type II) and the type III is from the internal pudendal artery, accounted for 16.3% (17/104) and 25% (26/104) respectively.
Conclusion
The most frequent type of PA origin was type I followed by type III then II. Knowing the different and most frequent types of anatomy of PA may help standardization and effectiveness of the PAE in developing countries