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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.

Background: Tropical pyomyositis is endemic in this environment yet a good number of patients with this condition are not detected on time. Clinical diagnostic criteria are often misleading and recourse to imaging techniques would appear mandatory if morbidity and mortality must be controlled. Aim: To identify the clinical and sonographic features of pyomyositis which could facilitate diagnosis. Materials and Methods: The demographic, clinical and sonographic findings in 48 consecutive patients aged between six months and 78 years who initially presented with palpable masses of the neck, abdomen, chest and limbs, 46 of which eventually proved to be pyomyositis were retrospectively compiled and analysed. Results: The most affected age group was the (1-20 years) age groups. More males than females, as well as more rural than urban subjects were affected. All referring physicians except 12 missed the diagnosis. The diagnosis of pyomyositis was correctly established with the aid of sonography in forty-six cases while two cases proved to be false positive. The most common causative organism was staphylococcus aureus. Two categories of lesions were identified sonographically namely: (1) The small ovoid solid hypoechoic lesion showing discrete swollen linear muscle fibres seen in the early part of the disease process. (2) The large partly solid partly fluid inhomogenously hypoechoic lesion demonstrating areas of partial myonecrosis usually seen in the later stages of the disease. The most frequently affected muscles in this series were those of the anterior abdominal wall. Conclusion: Ultrasound is effective in both diagnosis and therapy. It could enable a precise diagnosis to be made so long as the ultrasonic findings are evaluated in conjunction with the clinical features and laboratory findings such as ESR, WBC and culture/sensitivity of infected muscle aspirates. False-positives of pyomyositis are not uncommon and histological analysis of muscle biopsy specimens may occasionally be mandatory to arrive at a definite diagnosis. Sonography offers good guidance at both needle aspiration and muscle biopsy. It is easily available, cheap and radiation free. Journal of College of Medicine Vol. 11(1) 2006: 15-20

Aim: To study the clinical, radiological and histological patterns of bone tumours seen at the National Orthopaedic Hospital Enugu over a period of 13 years (1990–2003). Materials and Methods: The medical records of 56 patients with histologically proven diagnosis of bone tumours during the 13 years period were analysed.Results: Of the 56 cases studied, 31 were malignant and 25 benign. Of these also 35 were male and 21 female giving a male to female ratio of 17 to 1. The average age range was 5 to 76 years. The age range for the benign cases was 5 to 59 years and 10 to 76 years for malignant cases. Altogether 57% of males and 52.4% of females had benign lesions. In the benign group, the main presenting symptom was painless slow growing mass while in the malignant group the symptoms consisted of painful rapid growing tumour with occasional pathological fractures and disruption of function. The commonest benign lesions were ameloblastoma (9) and fibro-osseous lesions (11) while osteosarcoma was the commonest malignant lesion (8). Definitive diagnosis was based on clinical, plain film radiographic findings and biopsy findings. The benign lesions had excision/curettage done, while the malignant cases had ablation or amputations. Those with distant metastases were managed conservatively after tumour ablation. For some cases, recurrence occurred after surgery over a period ranging from 1 year to 22 years. The outcome in most of the remaining patients was not verified due to poor patient follow-up. Conclusions: The pattern of bone tumours in South-East Nigeria parallels those in South Western Nigeria and the Western World. Keywords: bone tumours, pattern, benign, malignant, Enugu Journal of College of Medicine Vol. 10(2) 2005: 94-101

Background: This report describes the unusual presentation and management of an urachal cyst in a 3½ year old Nigerian male child. Before being referred, he had been managed as a bladder rhabdomyosarcoma, and given two courses of cytotoxic therapy. Methodology: Pre-operative diagnosis was inconclusive, including the use of Ultrasonography and micturating cysto-urethrogram (MCUG). Abdomino-inguino-scrotal exploration revealed a pre-peritoneal multi-septate cyst spanning from the umbilicus to the dome of the urinary bladder. In addition there was herniation of this cyst into the right inguino-scrotal space. The cyst yielded 1.7litres of straw coloured fluid.Results: Drainage of the cyst with total excision of the sac in continuity resulted in cure. The patient has remained symptom free at 2years of follow up. Conclusion: This rare presentation of a benign condition stands to caution all practitioners against the irrational use of cytotoxic therapy. Keywords: urachal cyst, abdomino-inguino-scrotal Journal of College of Medicine Vol. 10(2) 2005: 72-74

Aim: To study the angiographic pattern of intracranial diseases encountered in Enugu following conventional carotid angiography (CCA) over an 11 year period.Method/Materials: The case notes, indications, request forms, films and radiological reports of all patients who had CCA were compiled and analysed. Results: Fifty nine patients consisting of 38 males and 21 females giving a male to female ratio of 1.8:1 were examined. Their ages ranged from 1 to 72 years with a mean age 31, 38. Indications consisted of suspicion of space-occupying lesion 52%, head injury 13.5%, proptosis 8.4%, suspicion of aneurysms based on previous computer tomographic (CT) or clinical findings 8.4%, stroke 5%, intracranial abscess, A.V fistula and others each 3.4%. The angiographic findings were as follows: normal findings 53.6%, subdural haematoma 13.6%. Aneurysms of communicating arteries 6.8%, other mass lesions 18.6%, A.V. fistulas, and vascular stenosis each 3.4% and epidural haematoma 1.7%. Conclusions: Space-occupying lesions are still the major indication for carotid angiography in our environment. This is followed by head injury, proptosis and suspicion of aneurysms, vascular stenosis is rare. CCA was a reliable and sensitive method for detection of cerebrovascular disease but not of tumours. It is also an excellent route for interventional procedures. The results of CCA and 3D imaging modalities are complimentary. The acquisition of more CT, MRI and angiography facilities by our health authorities should be encouraged so as to ensure more precise diagnosis at all times. Keywords: carotid angiography space occupying lesion, cerebrovascular diseaseNigerian Journal of Otorhinolaryngology Vol. 2(2) 2005: 70-76