[Show abstract][Hide abstract] ABSTRACT: ABSTRACT
Aim: To assess the level of inconsistency in replicating sonographic kidney size measurements in a
population of healtlry Nigerian children.
Subjects and Methods: In this prospective cross-sectional study, convenience sampling technique was
used to select a sample of Nigerian children. Both consent from participants and ethical approval from
the local authority were obtained before the study commenced. Three radiologists carried out the
replicate sonographic measurements using a DP-1100 mechanical sector scanner with a 3.5 MHz
convex probe. All examinations were done with subjects in the supine oblique position. Longitudinal
and transverse scans were performed. Renal lengths and widths were measured from the longitudinal
scans while thickness was measured from the transverse scans. Renal volumes were calculated with
ellipsoid formula Analysis of variance, Student's t-test, Pearson's correlation coefficient and z-test
were used to test the statistical significance of results. SPSS version 17.0 was used in the analysis of
results while statistical significance of all results was tested at p < 0.05.
Results: Mean intra-observer measurement errors in replicate sonographic measurements of kidney
sizes ranged from 0.36-0.43 cm, 0.22-0.63 cm, 0.37-0.52 cm and 5.93-9.62 ml for kidney length, width,
thickness and volume, respectively. Mean inter-observer measurement errors were in the range of 0.29-
0.48 cm, 0.18-0.23 cm, 0.34-1.82 cm and 5.92-7.28 ml for length, width, thickness and volume,
respectively. Mean intra-observer errors were not statistically significant (p > 0.05) but mean inter-observer
errors were (p < 0.05). Differences in all measurement errors of right and left kidney length,
width, thickness and volume were not statistically significant ( p> 0.05). Measurement errors correlated
weakly with kidney sizes Observer errors in renal length were not significantly different from what was
reported among Caucasians (p > 0.05) whereas that of volume was (p < 0.05).
Conclusion: Errors in replicate sonographic kidney size measurements obtained by a single observer
were less than errors in the same measurements by different observers; therefore, replicate sonographic
measurements by a single observer were more consistent among this population.
Keywords: Children, Nigeria, observer variability, sonography
Objetivo: Evaluar el nivel de inconsistencia cuando se repiten las mediciones sonogrdficas del tamafio
del rifi6n en una poblaci6n de niftos nigerianos saludables.
Sujetos y mdtodos: En este estudio prospectivo transversal, se utiliz6 la tdcnica de muestreo por
convenienciap ara seleccionaru na muestra de niftos nigerianos. Antes de comenzare l estudio,s e
obtuvo tanto el consentimiento de los participantes como la aprobaci6n dtica de la autoridad local.
From:r Departmenotf RadiationB iology,R adiotherapyR,a diodiagnosaisn d City, Edo stateN, igeria anda Departmenotf MedicalR adiographyN,n amdi
RadiographyF,a cultyo f ClinicalS ciencesC, oltegeo f Medicine,U niversity Azikiwe UniversityN, newi campusN, newi,A nambras tateN, igeria
of LagosI,d i-ArabaL, agosN, igeria,2 Departmeonft MedicaRl adiography
and RadiologicaSl ciencesF,a cultyo f HealthS ciencesa nd Technology, CorrespondenceD: r CU Eze, Departmento f Radiation Biology,
Collegeo f Medicine,U niversityo f Nigeria, Enugu campus,N igeri4 RadiotherapyR, adiodiagnosisa nd RadiographyF, aculty of Clinical
lDepartmenotf RadiologyU, niversityo f BeninT eachingH ospitalB, enin ScienceCs,o llegeo f Medicineo f TheU niversityo f LagosI,d i-arabaL"a gos,
NigeriaE -mail:f ame4eze@yahcooom
West Indian Med J 2013; 62 (8): 815
816 ObserverV ariability in SonographicM easuremenot f Kidney Sizes
Tres radi6logos llevaron a cabo la repetici6n de las mediciones sonogrdficas mediante un escdner de
sector mecdnico DP-1100 con una sonda convexa de 3.5 MHz. Todos los exdmenes se realizaron con
sujetos en posici6n supina oblicua Se realizaron escqneosl ongitudinales y transversales.L a longitud
y el ancho renales fueron medidos a partir de los escaneos longitudinales, mientras que el espesor se
midi6 a partir de los escaneos transversales. Los volumenes renales se calcularon con f6rmula
elipsoide. El andlisis de varianza, la prueba t de Student, el coeficiente de correlaci6n de Pearson, y
la prueba Z, fueron utilizados para probar la significaci6n estadistica de los resultados El programa
SPSS versi1n 17.0 fue utilizado en el andlisis de los resultados mientras que la significaci1n estadlstica
de los resultados fue probada en p < 0.05.
Resultados: Los errores intraobservadores promedio en la repeticiin de las mediciones sonogrdficas
de los tamafios de rifi6n variaron de 0.36-0.43 cm, 0.22-0.63 cm, 0.37-0.52 cm, 5 93-9.62 mL en
cuanto a longitud, ancho, espesory volumen, respectivamente.L os errores interobservadoresp romedio
de medici6n estuvieron en un rango de 0.29-0.48 cm, 0.18-0.23 cm, 0.34-1 82 cm y 5.92-7.28 mL de
longitud, ancho, espesor y volumen, respectivamente. Los errores intraobservadores promedio no
fueron estadtsticamentes ignificativos (p > 0.05) pero los errores interobservadoresfu eron (p < 0.05).
Las diferencias en todos los errores de medici6n del rifi6n derecho e izquierdo en relaci6n con la
longitud, ancho,e spesory volumen,n o fueron estadisticqmentsei gnificativos( p > 0.05). Los ercores
de medici6n guardaron una ddbil correlaci6n con los tqmafios del rift1n. Los errores de observador en
relaci6n con la longitud renal no fueron significativamente diferentes de lo que se inform6 entre los
caucdsicos( p > 0.05), mientrasq ue el resultadop ara el volumenfue (p < 0.05),
Conclusidn: Los errores en la repetici6n de las mediciones sonogrdficas del tamafio del rifi6n
obtenidas por un solo observado4 son menos que los errores en las mismas mediciones por diferentes
observadores.P or lo tanto, las medicioness onogrdficasr epetidasp or un ilnico observadore ran mds
consistentese ntre esta poblaci1n.
Palabras claves:N iffos, Nigeria, variabilidadd el observadors, onografia
The West Indian medical journal 12/2013; 62(8):815-822. DOI:10.7727/wimj.2012.262 · 0.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to determine the measurement of normal range of ultrasound (US) thyroid gland dimensions in school-aged children (6-16 years) in our environment and compared with what is obtained elsewhere.
A prospective ultrasound measurement study done in University of Benin Teaching Hospital Benin, Nigeria.
A prospective ultrasound (US) study of thyroid dimensions of 500 school-aged children in our environment consisting of 227 boys and 273 girls was done from 1 December 2006 to July 2007. The subjects were examined by the authors and subjects with palpable abnormal thyroid gland were excluded from the study. The thyroid dimensions (length, height, and diameter) were taken for each lobe by means of ultrasound (US). In addition volume of each thyroid lobe was calculated and the summation of volume of the lobes was taken as thyroid gland volume of each subject. Also height and weight of patients were documented from which the subject's body surface was calculated. Incidental thyroid gland lesion in US was excluded from the study. Using the Statistical program of social science (SPSS) and INSTAT (Graph Pad Inc. USA) the data were analyzed. Informed consent was obtained from all the subjects and the study was done in line with the ethical guidelines of the centers.
The US thyroid gland volume in school-aged children in Benin City from this study ranges between 1.17 cm 3 and 7.19 cm 3 , mean volume range of 1.76-4.95 cm 3 , median volume range of 1.73-4.73 cm 3 , and range of standard deviation from 0.39 cm 3 to 1.49 cm 3 . The average mean thyroid volume is 2.32 cm 3 with the following average dimensions; anteroposterior right lobe =1.06 cm, mediolateral right lobe = 1.01 cm and craniocaudal right lobe = 2.34 cm, and anteroposterior left lobe = 1.01 cm, mediolateral left lobe = 1.04 cm and craniocaudal left lobe = 2.41 cm for both boys and girls respectively. These data are significantly lower than data obtained by European based World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) 1997. However there is significant similarity with data obtained in similar environment.
Ultrasound thyroid gland dimensions in school-aged children in our environment are reproducible and the data obtained are comparable to those obtained in other environment. The values may be better used in our environment as reference data for screening purposes.
Nigerian journal of clinical practice 07/2012; 15(3):285-92. DOI:10.4103/1119-3077.100622 · 0.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To find out the state of radiation protection and monitoring practices of the public and private X-ray centres in Edo state.
Survey visits were made to all the functional X-ray facilities in Edo state and the available facilities identified, staff interviewed and collected data analyzed.
There are 18 functional X-ray facilities comprising 10 (55.56%) publicly owned and eight (44.44%) privately owned. Only two (20%) of the public and five (62.5%) of the private X-ray units have personnel and environmental monitoring. All the X-ray centers in both public and private hospitals have effective lead aprons. All the public (100%) and only four (50%) of the private centers have gonadal shield although none is using them on a routine basis. Qualified radiographers are available only in five (50%) of the public and six (75%) of the private centers. Only three (30%) of the public X-ray centers have the services of radiologists. Among the private X-ray units, five (62.5%) have radiologist while three (37.5%) have no radiologist. Only one (10%) of the public centers and one (12.5%) private X-ray centre have a purpose-built adequately designed X-ray unit with barium plasters and lead lining of walls and doors. There is also only limited lead lining of doors and walls in three (37.5%) private units while no lead lining or barium plasters are used in five (62.5%) of the private units. No X-ray unit in Edo state uses digital radiography or computerized information system. This means that lost hard copy must be repeated, leading to more radiation to patients and staff.
There are inadequate radiation protection and monitoring practices in most of the functional X-ray facilities in Edo state with only five (62.5%) of the private and two (20%) of the public X-ray units monitored. There is poor adherence to the advice of the medical physicists due to the cost implications of the implementation.
Nigerian journal of clinical practice 07/2011; 14(3):308-10. DOI:10.4103/1119-3077.86774 · 0.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study is to assess the effect of CD4 T lymphocytes, on features of pulmonary tuberculosis on HIV positive patients with co-existing tuberculosis attending clinic in university of Benin Teaching Hospital Benin Nigeria.
University of Benin Teaching Hospital Benin, Nigeria.
This study was carried out on 200 patients who had laboratory confirmation of HIV, CD4 T lymphocytes measured, with tuberculosis co-infection, and control group of 100 patients, who were HIV negative, but positive for tuberculosis infection, between 1st July, 2003 and 30th May, 2004, were further examined with chest radiography, in the hospital. The standard procedures of chest radiography were used, with minor adjustment to allow good image quality on the radiograph. Two Radiologists analyzed these on standard image viewing box.
The average CD4 T lymphocyte count in the study group (HIV sero-positive) was 173.90 cells/nl and median of 172 cells/nl. 128 (64%) subjects had CD4 T lymphocyte counts less than 200 cell/nl while 72(36%) subjects had CD, lymphocyte count above or equal to 200 cells/nl. 111 (86.72%) subjects with a CD4 T lymphocyte count less than 200 cells/nl and 31 (43.1%) subjects with CD4 T lymphocyte count 200cells/nl or more had an atypical chest radiographic pattern of primary pulmonary tuberculosis. Atypical chest radiogra phic pattern was more frequent among patients with CD4 T lymphocyte count less than 200 cell/nl (86.72%) compared with patients with CD4 T lymphocyte count greaterthan 200 cells/nl (43.1%) (P < 0.001).
There is significant relationship and correlation between immune status of HIV positive patient and pulmonary pattern of tuberculosis. The variation on pulmonary pattern of tuberculosis noted also collaborated well with the level of CD4 T lymphocyte in the patients.
Nigerian journal of clinical practice 09/2010; 13(3):254-9. · 0.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Proforma information, instructions and procedures of training in radiology are lacking in Nigeria.
To describe the errors in ultrasonography performed by unsupervised trainee radiologists.
The radiology records of all ultrasound scans (USS) carried out and all reports that came back to the unit of the authors on account of misdiagnosis, doubtful diagnosis, misinformation or error in the reports were studied. The patients with the returned reports were rescanned where available by consultants and the collected data analysed.
A total of 4680 patients had ultrasound studies without supervision resulting in 605 (12.93%) queried reports. The USS scans of 235 (5.02%) patients were repeated with consultants in attendance resulting in significant change in reports of 95 (2.03%) patients. Analysis of the request cards of 605 queried reports showed omission of relevant clinical information 463 (76.53%), outright wrong information 65 (10.73%),and unconventional abbreviations 139 (22.98%), while 493 (81.49%) were completed by a nurse, medical student or junior resident. Typographical errors comprised 174 (28.76%) of the 605 queried reports. False negative error was the highest type of error seen in 55 (57.89%) of the 95 patients with significant change in their report after repeat scan as lesions not detected were not documented.
Trainee radiologists make significant errors in carrying out and reporting ultrasonography without adequate direct supervision of the study by their training consultants. Majority of the errors originate from lack of accurate filling of the patients request cards by the requesting physicians, lack of adequate preparation for the intended study, and typographical errors in writing reports. False negative reports are by far the greatest cause of errors recorded as lesions not detected were not documented.
West African journal of medicine 01/2009; 28(4):257-61.
[Show abstract][Hide abstract] ABSTRACT: Isolated dextrogastria is a rare congenital anomaly in which the stomach is right-sided while the intestines, the organs in the chest, and the other organs in the abdomen are in normal situs. The importance of recognising the spectrum of situs anomalies is because the altered anatomy associated with these anomalies may result in misdiagnosis.
To report a case of isolated dextrogastria in an 18-year old woman who was seen during pre-university admission medical examination.
The routine chest X-ray of a young woman as a part of pre-admission medical examination showed the gastric air bubble under the right diaphragm rather than on the left. She was then subjected to further clinical and radiological evaluation.
The personal, past and family histories were uneventful as was the physical examination. Trans-abdominal ultrasonography showed a normal-sized and a normally sited liver in the right hypochondrium with normal gall bladder, and normally sited left and right lobes of the liver. The liver echo pattern was normal. The stomach was found below the lower border of the right lobe of the liver. The kidneys and the spleen were normal in number, position, size and architectural pattern. A barium meal showed a well-defined and a well developed stomach with a reverse J shape and duodenal C loop that was reversed in shape.
The practice of the radiographer is always placing the marker before exposing the film instead of marking the radiograph after processing, which is the key to accurate identification of situs anomalies need emphasis.
West African journal of medicine 01/2009; 28(4):270-3.
[Show abstract][Hide abstract] ABSTRACT: Objectives. To study the neuro-imaging findings in patients with acute confusional (AC) states with a view of diagnosing the organic conditions that cause AC states.
Setting. Radiology Department of a University Teaching Hospital.
Method. Retrospective analysis of brain computed tomography (CT) films, radiology and medical records of patients who underwent CT scans on account of AC states. The study brain CT scans were conducted over a three-year- period (from 1st March 2001 to 28th February 2003).
Result. Twenty five patients, (12 males and 13 females) who were referred to the CT scan unit of a University Teaching Hospital had their CT scan findings and presenting symptoms studied. The patients’ age range was from 40 to 69 years, with the 65 – 69 years having the highest frequency of 7 (28%) and the mean age was 63 +/- 6 years. All the patients presented with acute confusional (AC) states. In addition to AC states, other symptoms or presenting history were hallucination observed in 9 patients (36%), stroke in involution seen in 5 patients (20%), coexisting diabetes and hypertension 4 patients (16%), electrolyte imbalance 3 (12%), drug ingestion/intoxication 2 (8%), vomiting and neck pain 1 (4%) while 1 (4%) patient presented with history of steroid therapy. In the CT scan findings, 22 patients (88%) had abnormal while 3 patients (12%) had normal findings. The commonest findings were multiple areas of acute cerebral infarction with focal areas of post infarction atrophy in 10 (40%) patients, acute intracerebral haemorrhage with areas of previous focal chronic infarction in 5 (20%), acute intracerebral haemorrhage in 3(12%), and subacute large thrombotic unihemispheric infarct in 2 (8%) patients. There were acute intraventricular haemorrhage in 1(4%) patient and generalised cerebral atrophy in 1 (4%) patient.
Conclusion. CT scan can help in early diagnosis of the organic and treatable conditions that cause AC states instead of grouping all the diagnosis together as chronic progressive dementias. From the result, 88% of the patients had organic intra-cerebral lesions causing AC states and many of them are treatable and preventable. Where they are available and when the patients can afford them in developing countries, neuro-imaging studies are advised in elderly patients with AC states for early diagnosis of treatable conditions that cause AC states.
[Show abstract][Hide abstract] ABSTRACT: A case report of a fifty years old Hausa male from Sokoto town, Nigeria an endemic region of guinea worm infestation, who presented with sudden adult onset of asthmatic attack and was evaluated radiologically and the diagnosis of acute obstructive airway disease was confirmed. It was noted, that there were associated calcified chain of guinea worms in the lung parenchyma. A rare association of acute asthmatic attack. Patient responded there-after to an anti-asthmatic regime of management.
[Show abstract][Hide abstract] ABSTRACT: Acute abdomen is a clinical diagnosis and not a definitive one. The use of ultrasound in management and diagnosis of acute abdomen is rarely invoked in our environment. The importance of definite diagnosis in surgical and medical management cannot be overemphasized
To report a case of ultrasound diagnosis of retrocaecal appendicitis.
A nine-year-old male child presented with vomiting, vague abdominal pain, diarrhoea, and fever, which led to the following differential diagnoses; acute food poison gastro-enteritis, typhoid enteritis, malaria and acute appendicitis. He was investigated along these lines. He had abdominal ultrasonography and CT scan .
The ultrasound showed evidence of acute appendicitis. The findings on CT and surgery confirmed the diagnosis. Post-operatively, he made uneventful recovery.
The use of ultrasound in acute abdomen is rarely invoked in our environment which may lead to unquantifiable consequences both in management and complications.