Perfomance measures of diagnostic ultrasound of the breast in Lagos University Teaching Hospital (LUTH), Nigeria

The performance of Ultrasound (US) among patients presenting with signs and symptoms of malignancy was studied in comparison to surgical pathological findings. 310 patients who presented to the surgical out-patients of the Lagos University Teaching Hospital with signs and symptoms of breast cancer, between 2002 and 2003 were sonographically evaluated. US was performed with Sonoline SL-I (Siemens AG Germany) using a 7.5 MHz linear array transducers. The sonographic appearances were prospectively classified using the Breast Imaging Reporting and Data System (BI-RADS) assessment categorization. Histological confirmation following surgical excision was correlated with US. The overall sensitivity of diagnostic US in the study was 83.9% (95% CI 79.8-88%), while PPV, specificity, NPV and accuracy were 96.3% (95% CI 94.2-98.4%), 99.2 (95% CI 98.2-100%), 96.1% (95% CI 93.9-98.3%) and 96.1% (95% CI 93.9-98.3%) respectively. Univariate analysis showed that sensitivity and specificity generally declined as breast fattiness increased. Diagnostic US is useful in characterizing breast lesions. This study analyzed the performance of US and shows that the resultant specificity is high; however it may have to be used in conjunction with needle biopsy to achieve improved sensitivity and avoid unnecessary benign surgical biopsies. Nigerian Medical Practitioner Vol. 49(1&2) 2006: 28-3

Hysterosalpingography and Risks of HIV Dissemination in Women

Hysterosalpingography (HSG) represents an important imaging procedure in the investigation of infertility and may be associated with high pregnancy rate as a therapeutic effect. Whereas less traumatic and infection-free techniques of HSG have been embraced in the developed countries using disposable catheters, the traditional method which employs sterilizable metal cannula with potential to cause tissue laceration and infection dissemination continues to be used in Nigeria. This report attempts to discourage the use of such shared instrumentation in order to prevent horizontal dissemination of HIV infection among female patients. Over a seven month period, 746 HSGs were performed using predominantly sterilizable metal cannula or disposable catheters when the former fails. Analysis of the age of patients, type of instrumentation and outcome of the HSG procedure was undertaken and tabulated. The HSG workload out of a total radiologic procedure of 4039 is 746 (18.47%). The mean age of the patients is 33 years. Of the 707 HSGs carried of with sterilizable metallic cannula, contrast medium reflux into the pelvic veins was recorded in 133 (17.83%) cases, whereas this phenomenon was absent in instrumentation with disposable catheters. Venous intravasation during HSG procedure carries a risk of horizontal dissemination of HIV virus when sterilizable metallic cannula is employed. This may be prevented through the use of disposable catheters. Keywords: Hysterosalpingography, HIV, Infection, RiskNigerian Hospital Practice Vol. 2 (2) 2008: pp. 37-4

Diagnostic value of high resolution ultrasound in localisation of the undescended testis in children

Background: The use of ultrasonography in the pre-operative localisation of undescended testes has become controversial due to fears about its  accuracy. This study was designed to ascertain the accuracy, sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography in the localisation of the undescended testes in children.Patients and Methods: A prospective evaluation of all boys undergoing operation for undescended testes at the Lagos University Teaching  Hospital, Idi-Araba, Lagos, over a 12 month period was performed. Thepre-operative clinical and ultrasound fi ndings were compared with the fi ndings on surgical exploration.Results: Forty boys with 52 undescended testes were studied. The mean age of the boys at the time of surgery was 4.0 ± 0 years (range 1-11  years). Fortysix (88.5%) testes were localised pre-operatively by ultrasound- 20 of 22 (90.9%) palpable testes and 26 of 30 (86.7%) non-palpable testes. Intra-operatively, 49 (94.2%) of the undescended testes were found while 3 (5.8%) were absent/vanishing testes. Ultrasoundevaluation had an accuracy of 86.5%, sensitivity of 89.8%, and specifi city of 33.3%, PPV of 95.7% and a NPV of 16.7%.Conclusion: Ultrasound assessment is beneficial in pre-operative  evaluation of children with undescended testes. Key words: Children, pre-operative assessment, ultrasonography,  undescended teste

Knowledge, Attitude and Practice of Breast Cancer Screening among Nurses in Lagos University Teaching Hospital, Lagos Nigeria

No Abstract