Preliminary Findings on Metastatic Brain Tumors in Enugu, Southeast Nigeria

Background: Metastatic brain tumors (MBTs) are the most common brain neoplasms seen clinically and are often associated with poor outcomes. This study highlights the demographic, clinical, and radiological profiles as well as outcomes of MBTs managed in a tertiary hospital in Southeast Nigeria. Methods: This was a 1-year prospective observational study of patients with MBT who presented to the neurosurgery unit of the University of Nigeria Teaching Hospital, Enugu, from December 2018 to November 2019. Data on the demography, clinical and radiological features, treatment, and outcomes were collected and analyzed. Results: Of the 31 patients with MBTs, 58.1% were female and 41.9% male. The mean age was 51.0 ± 15.2 years. The most common presenting features were limb weakness (77.4%), headache (58.1%), and personality changes (54.8%). About a quarter (26.7%) were fully conscious at  presentation. Only 45.2% knew that they had a systemic malignancy (SM) before presentation. The breast (29.0%), lungs (22.6%), and skin (19.3%) were the common sources of metastases. The lesions were solitary in 25.8% and multiple in 74.2%. They were predominantly frontal (80.6%), with bilateral distribution in 64.5% of patients. Radiotherapy was done in 58.1% and surgery in 6.5% of patients. Prior knowledge of the existence of a SM (P = 0.045) and unilateral brain involvement (P = 0.013) were associated with better 30-day survival. Conclusion: The breast is the most common source of brain metastasis. Prior knowledge of the existence of a SM and unilateral brain involvement is associated with better short-term survival. Keywords: Brain, metastasis, primary, surviva

Ultrasound Findings in the Gallbladder of Sickle‑Cell Patients: A Cross‑Sectional Study in Enugu, Nigeria

Background: Sickle‑cell disease (SCD) causes chronic and recurrent hemolysis which is a recognized risk factor for gallbladder (GB) disease. The prevalence of GB disease in SCD is high and increases with age. Cholelithiasis and cholecystitis are relatively common GB diseases in SCD. They are important causes of acute abdominal pain in SCD and also increase morbidity. Ultrasound is a cheap and noninvasive means of evaluating the GB; it has a high degree of accuracy and is widely available. Aims: The aim of this study is to sonographically evaluate the GB of SCD patients in steady state at the University of Nigeria Teaching Hospital (UNTH), Ituku‑Ozalla, Enugu, and to determine the prevalence of specific GB diseases in SCD patients. Materials and Methods: A prospective cross‑sectional study of 130 known SCD patients attending sickle‑cell clinics at UNTH and 130 controls. Ultrasound of the GB was done after at least 6 h fast, using a Dp2200 mindray mobile ultrasound machine equipped with a 2.5–5 MHz convex probe. The data were analyzed using the SPSS software version 16. Results: The GBs of 130 consecutive SCD participants and 130 control group were sonographically evaluated. The prevalence of cholelithiasis in SCD was 10.8%, whereas the prevalence of cholelithiasis in the control group was 3.1%. No other GB diseases were seen. The mean dimensions of theGB for the study group were length (65.78 ± 9.85 mm), width (29.15 ± 6.01 mm), depth (25.58 ± 5.81 mm), wall thickness (1.59 ± 0.74 mm), and volume (26.52 ± 11.18 cm3). Conclusion: The prevalence of cholelithiasis in sickle cell disease in southeast Nigeria is 10.8% while the prevalence of cholelithiasis in the control population is 3.1%. Keywords: Cholecystitis, cholelithiasis, gallbladder, sickle cell disease, ultrasoun

Renal angiomyolipoma in pregnancy: surgical management with fetal preservation - Approach in a developing setting

Renal angiomyolipomas (RAML) are uncommon benign renal tumours that are associated with a tendency to rupture resulting in sometimes- torrential retroperitoneal hemorrhage as the Wunderlich syndrome or as severe potentially exsanguinating hematuria. When hemorrhage from RAML occurs in pregnancy it presents a unique challenge requiring timely and appropriately adapted intervention with the goal of preventing fatality, preserving renal function as well as preventing fetal loss if possible. We report the management of severe bleeding from RAML in pregnancy and highlight the need to adopt a management strategy that suits the practice environment and offers the patient standard and enduring care

Complementary roles of hysterosalpingography and transabdominal ultrasonography in the assessment of the uterus among women with infertility in a developing nation

Background: The uterus plays a vital role in female infertility. In our environment, it is commonly separately examined with either transabdominal ultrasonography (TAUS) or hysterosalpingography (HSG) which are cheap and readily available. A concurrent use of the two procedures might have a complementary effect with a good outcome especially in a developing economy where three dimensional (3-D) ultrasound, sonohysterography and magnetic resonance imaging (MRI) which are more sensitive are neither readily available nor affordable.Objectives: To document the uterine, tubal and adnexal lesions diagnosed using each of the two procedures and to check if the procedures can complement each other in a poor resource economy.Methodology: This is a six month, paired group and analytical observational study of 200 women with infertility. HSG was booked in keeping with the ten-day rule and TAUS was performed on the same day before HSG. Statistical Package for Social Sciences, version 21 was used for the analysis. Ρ ≤ 0.05 was considered statistically significant.Results: With TAUS evaluation, 158(79%) of the subjects appeared normal. Fibroids were detected in 39(19.5%) subjects, and in 37(94.9%) of this subset, they were localized. Intrauterine adhesions were seen in 0(0%), endometrial polyp in 1(0.5%), and endometrial hyperplasia in 2(1%). With HSG, 149(74.5%) appeared normal. Fibroids were detected in 27(13.5%) and in 19(70.4%) of this subset, they were localized. Intrauterine adhesions were seen in 23(11.5%), endometrial polyp in 1(0.5%) and endometrial hyperplasia in 0(0%). With HSG, tubal occlusion was seen in 63(31.5%), peritubal adhesions in 34(17%), hydrosalpinges in 5(2.5%) and loculated spill in 7(3.5%). None of these were seen with TAUS. With TAUS adnexal masses were in 12(6%) and with HSG they were demonstrated in 2(1%). There was significant difference between TAUS and HSG findings with regard to detection of fibroids, localization of fibroids, detection of tubal lesions and detection of adnexal lesions.Conclusion: The two modalities played important complementary roles since TAUS was able to detect more lesions on the wall of the uterus and in the adnexae, while HSG was able to detect more intracavitory and tubal lesions. The combined study is recommended especially in a poor resource economy where other more sensitive modalities are neither available nor affordable