Background: Despite the safety, affordability, and widespread use of ultrasound (US); there is paucity of literature on ultrasonographic assessment of portal vein (PV) diameter in adult patients in our environment. This study was aimed at determining the mean and range of PV diameter in normal adults in northeastern Nigeria. Patients and Methods: This cross-sectional prospective study was carried out at the University of Maiduguri Teaching Hospital between January and June, 2013. Two hundred and fifty normal adult male and female patients aged 18 years and above underwent abdominal ultrasonography for measurement of their main, right, and left PV diameter in both inspiration and expiration. The relationship between the PV diameter and age was correlated using Pearson's correlation test. While the difference between the two sexes and phases of respiration were compared using Student's t-test. Results: There were 187 (74.8%) males and 63 (25.2%) females aged between 19 and 77 years, mean 43.78 ± 12.97 years. The mean diameter of the main PV was 10.87 mm ± 0.81. The mean diameter of the right and left PVs were 4.35 mm ± 0.52 and 4.12 mm ± 0.52, respectively. The PV diameter correlated with age and respiratory phases (P < 0.05). There was statistically significant difference in PV diameter between males and females (P < 0.05) with values higher in females. Conclusion: The mean PV diameter in normal adults has been established in northeastern Nigeria. The diameter correlated with age and showed significant difference between the two sexes and respiratory phases.

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Aphallia or penile agenesis is complete absence of the penis due to complete or partial failure in the phallic development of the genital tubercle. It is a rare form of genital ambiguity with an estimated incidence of 1 in 10-30 million births and <100 cases reported till date. Very few cases have survived to adulthood. We report a case of aphallia, who presented to us at the age of 45. Clinical presentation in an adult is the absence of the penis with a normal scrotum, normally descended testis and well developed secondary sexual characters. This is best evaluated by magnetic resonance imaging while treatment options vary from gender reassignment during infancy to phalloplasty and urethral transposition in adulthood. Preservation of urinary continence and maintenance of urinary outlet should be the primary aim of treatment of aphallia in an adult.

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Trauma has been on the increase worldwide with significant morbidity and mortality, especially when it occurs in the form of polytrauma. The management of these patients has witnessed significant changes over the last decade with the better understanding of the pathophysiology of polytrauma and the recognition of the benefits of early fracture stabilization as part of the damage control orthopedics (DCO) surgical resuscitation of these patients. Inspite of these, the operability of the polytraumatized patients occasionally becomes contentious amongst the surgical trauma team. Available evidence, shows that the focus of polytrauma resuscitation in contemporary trauma surgical practice has now shifted to the operating room, to improve outcome in polytrauma management. An electronic search was done in the PubMed and EBSCO databases for relevant published articles on polytrauma. The terms "Polytrauma OR Multiple trauma" AND operability were entered. Only original articles on multiple trauma involving long bone(s) fractures and at least a thoracic injury not requiring intensive care treatment, or head injury with an initial Glasgow coma score ≥ 8 points or both, published in the last 2 decades were reviewed. In addition, the references from some of the retrieved articles were also reviewed to identify suitable articles.

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Intestinal obstruction is a very common cause for presentation to the Emergency Department while internal hernia is a rare cause of obstruction. Among internal hernias, defects of the broad ligament (BL) are extremely rare. Defects of the BL can be either congenital or secondary to surgery, pelvic inflammatory disease, and delivery trauma. Herein, we report a 43-year-old lady, who presented with signs and symptoms of perforated small bowel for which a diagnosis of acute peritonitis was made. At laparotomy, the cause of the perforation was found to be an internal hernia through a defect in the right BL. Surgical management was taken with a smooth postoperative course.

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Published reports of different synchronous tumours in both ovaries are scanty, and the few reported cases are mostly malignant. This report of synchronous benign tumors in both ovaries occurred in a 26 year old female who presented with one year history of painless abdominal swelling and two large multicystic masses on ultrasound scan. She had bilateral oophorectomy and histology revealed right sided benign cystic teratoma and left sided mucinous cystadenoma. Conclusion: Both tumours were benign and therefore potends no adverse consequences for the patient. Nonetheless, given the unusual presentation, she is being followed up.

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A 25-year-old male with a diagnosis of exstrophy epispadias complex underwent surgery at the age of 5 and 15 years. Last surgery done was augmentation cystoplasty with mitrofanoff procedure which eventually failed, and he presented with incontinence and dysuria. Ultrasonography and contrast-enhanced computerized tomography revealed multiple large stones; the largest was 7 cm in size. The patient underwent an open cystolithotomy for removal of the stones weighing 1.25 kg. Largest reported stone burden in an augmented bladder in the literature is 1.4 kg until now.

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Background: Pregnant women with previous history of recurrent miscarriage have higher risks of adverse pregnancy outcomes. Management of current pregnancies in patients with recurrent miscarriage is distressing for the patient and frustrating for the health care provider, especially where treatment options are limited. Doppler velocimetry studies of pregnant women in second trimester with recurrent miscarriage can predict adverse pregnancy outcomes. In this paper, we predict pregnancy outcomes using Doppler velocimetry among women with recurrent miscarriage. Patients and Methods: It was a prospective study among pregnant women with history of recurrent miscarriage. The umbilical artery Doppler velocimetry was carried out in second trimester using 3.5 mHz convex of the Mindry Digital Ultrasound Imaging System (Model DP-8800Plus; Shenzen Mindray Biomed electronics, China). Results: A total of 67 pregnant women with history of recurrent miscarriage were recruited for the study. The mean age ± standard deviation was 28.94 ± 5.59. Thirty-nine (58.21%) had abnormal resistive indices of which 15 (22.39%) had diastolic notches. Others had normal resistive indices. There were significant associations between high resistive index (RI) and the occurrence of preterm birth, low Apgar scores, low birth weight, and intra uterine fetal death. Conclusion: Majority of high risk pregnant women with history of recurrent miscarriage have high umbilical artery RI in second trimester of gestation. RI of at least 0.715 of the umbilical artery Doppler velocimetry is associated with adverse pregnancy outcomes following receiver operating characteristic analysis. Abnormal umbilical artery Doppler velocimetry among pregnant women with recurrent miscarriages predicted adverse neonatal outcomes.

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Angiogenesis is a physiological process through which new blood vessels are formed from the existing blood vessels. It is a multistep process, involving proliferation of activated endothelial cells (ECs) and migration of ECs to target organs. At target organs, the ECs get organized into capillary tubes and synthesize new basement membrane. These capillary tubes then get canalized to form a vascular lumen. The process of Angiogenesis plays an important role in growth and progression of cancer. The control of tumor angiogenesis depends upon the net balance of angiogenic factors (activators) and antiangiogenic factors (inhibitors), which are secreted by both tumor cells and host cells. The key signaling angiogenic factors include vascular endothelial growth factor (VEGF), Notch, angiopoietin, ephrins, transforming growth factor beta, and platelet derived growth factors (PDGFs). The potential therapeutic implication of tumor angiogenesis was coined by Folkman in 1971. The knowledge of tumor angiogenesis can be utilized in the development of novel strategies of anticancer therapy by targeting tumor vessels instead of tumor cells. It works best when combined with cancer chemotherapy. However, there are many hurdles to the road of success. The long-term survival and overall improvement in advanced cancer are still limited, and the final outcome may be different from what is obtained in experimental animals. In this article, an effort is made to address the process of angiogenesis, the basic molecular biology of key signaling pathways and the concept, present status and challenges in cancer therapeutics as far as angiogenesis is concerned.

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Background: There is a global concern about poor awareness of fertility. Knowledge of fertility period even among fertile women will reduce the burden of infertility. The objective of this study was to determine the awareness of fertility period among fertile women at Aminu Kano Teaching Hospital (AKTH). Patients and Methods: It was a descriptive study among 220 consenting women at AKTH over a period of 3 months, following approval by the hospital management. Structured pretested questionnaires were administered. Data were analyzed with a computer using Statistical Package for Social Sciences (SPSS) version 17 computer software. Results: Two hundred and twenty women were recruited. The mean age ± standard deviation (SD) were 28.47 ± 5.91. One hundred and eighty-four (83.64%) of the respondents knew the duration of their menstrual interval, while 36 (16.36%) were unaware. Menstrual intervals of 30 days was the model (24.50%) followed by 28 days (20.50%). One hundred and seventy-one (77.70%) respondents were aware that pregnancy is related to menstrual cycle, while 49 (22.30%) were not aware. Also, 129 (58.60%) knew their last menstrual periods, while the remaining 91 (41.40%) did not. One hundred and seventeen (53.20%) respondents knew what fertility period meant, while 103 (46.80%) were ignorant of it. Only 85 (38.60%) of the respondents were aware of their fertility periods, while 135 (61.40%) were not. Similarly, only 13 (5.90%) knew any method to determine fertility periods, while 207 (94.10%) did not. Conclusion: The study revealed good knowledge of fertility awareness among fertile women, but awareness of fertility period was lacking.

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Mucoepidermoid carcinoma (MEC) of the sinonasal area is very rare and frequently misclassified. We report a 43-year-old woman who presented with persistent nasal blockage, epistaxis, progressive right cheek swelling and ipsilateral proptosis. The affected eye's vision was low, to identifying only fingers at 6 m. She also had hypoesthesia over the right cheek and distortion of the ipsilateral external nasal pyramid. There was also a fleshy mass filling the right nasal cavity, causing the deviation of the nasal septum to the contra-lateral side. A diagnosis of a malignant nasal mass was made. Following the nasal polypoidal mass biopsy a histological diagnosis of MEC was made. The patient had complete evaluation including computed tomography scan of the sinuses and underwent extensive surgical resection and postoperative radiotherapy. The patient is doing well on follow-up.

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Background: It is important to predict the severity of acute pancreatitis as early as possible in order to optimize the therapy and to prevent organ dysfunction and local complications. Several scores of severity have been proposed. New biochemical markers are now available besides physiological and radiological markers. Our study was done to know the relation between interleukin 6 (IL-6) concentrations, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores and computed tomography (CT) severity index in acute pancreatitis. Patients and Methods: The study was done in Jawaharlal Nehru Medical College, Aligarh Muslim University from December 2011 to November 2013. Blood sample was taken between 24 and 48 h from the onset of symptoms and IL-6 was assessed using ELISA method and compared with physiological APACHE-II and CT Severity scores. Results: Mean IL-6 levels were found to be higher in higher APACHE-II score categories and the difference was significant statistically (P < 0.001). The correlation (Spearman's rank coefficient) also indicated a strong bivariate correlation of APACHE-II scores with IL-6 levels (ρ > 0.7). However, the IL levels did not correlate with the modified CT severity index. Conclusion: APACHE-II scores show a strong correlation with IL-6 levels within the limitation of having patients of only lower order of APACHE-II scores. Nonsignificant correlation with CT severity index was found. This should encourage us to use biochemical parameters to determine the severity of acute pancreatitis instead of CT standards.

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Background: Cardiovascular disease (CVD) is now a public health problem due to its high prevalence and associated high morbidity and mortality. Measurement of aortic diameters can help in predicting CVD in patients. The objective of this study was to determine the normal value of infrarenal and suprarenal transverse aortic diameter and their relationship on ultrasound among adults in Zaria, Nigeria Patients and Methods: Three hundred consecutive Nigerian adults without CVD attending ultrasound unit of Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria, were recruited for this study. Routine protocol for scanning the abdomen in the transverse, longitudinal and craniocaudal planes were used to scan the aorta for supra- and infrarenal dimensions. Results: The mean suprarenal aortic diameter (SAD) of the subjects was 1.79 ± 0.25 cm with a range of 1.15-2.61 cm. The mean infrarenal aortic diameter (IAD) was 1.63 ± 0.23 cm with a range of 1.01-2.46 cm. The mean ratio of infra- and supra-renal diameter was 0.91 (±0.04), in male subjects, it was 0.92 (±0.04) and in female subjects, it was 0.90 (±0.05). IAD, IAD/SAD ratio, and weight were independent predictors of SAD on multilinear regression analysis. SAD, IAD/SAD ratio, age and body mass index were also independent predictors of IAD. Conclusion: This study has established the normal ratio values of infrarenal to suprarenal transverse aortic diameter in healthy adults and the factors that correlate with transverse aortic diameter, as well as independent predictors of transverse aortic diameter in Zaria. These values would be of help to radiologists, surgeons, and other clinician in the diagnosis, management, and follow-up of cardiovascular patients.

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There are different techniques for reconstructing the eyelids and canthal area which may need modifications in some situations for proper reconstruction. Three cases of sebaceous gland carcinoma of the lids were done by different techniques, where the extent of the disease required subtotal lid excision. At 3 weeks when healing was noted and the histopathology reports were available, the second stage reconstruction was done along with tissue block excision. The block was excised from the site of graft-host junction showing margin involvement on histopathology. In the first case, the base of the excised margin showed infiltration following tumor excision, and hence a basal block of tissue was excised during second stage surgery. In the second case, the excised margin showed tumor involvement, so a lateral block of tissue was excised in second stage surgery. In the third case the deep basal block of tissue was excised during first stage only. In all the three cases, the excised block was free from tumor, but patient were kept on close follow-up. The technique has worked well in all the cases as no recurrence has occurred in 1-year follow-up. None of these patients received any radiotherapy or chemotherapy postoperatively. The postoperative appearances were normal with adequate functioning lids and earlier rehabilitation.

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Abdominal cocoon (AC) is a rare cause of small bowel obstruction. Furthermore, known in the literature as sclerosing encapsulating peritonitis is described mostly in young adolescent girls. The striking feature of AC is a total or partial encasement of the small bowel by a thick, fibrocollagenous membrane. There are no specific clinical features and, therefore, a diagnosis before surgery is very difficult. We report a case of AC presenting with abdominal lump and features of intestinal obstruction in a young lady who had a successful outcome after surgical treatment.

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Background: Malignant melanoma with its varied clinical presentations and histopathological patterns poses diagnostic problems both for clinicians and pathologists. It presents as metastatic lesions or in an unusual site with no known primary. We present three cases of malignant melanoma to demonstrate the wide array of clinical presentations of this entity. Patients and Methods: A 5 years retrospective study of all melanotic lesions, both benign and malignant irrespective of the site was done. Among these, three cases of malignant melanoma were selected, that evaded clinical diagnosis because they occurred in unusual locales and caused diagnostic difficulty in initial screening procedures. The diagnosis was confirmed only after pathologic examination and immunohistochemistry (IHC). Results: Of the three cases, one presented as an intracranial hematoma, the second as a pseudo cyst of pancreas and the third as a parotid gland tumor. The first two cases were metastatic and the third was a primary. Conclusion: Diagnosis of malignant melanoma may provide a challenge, especially when the primary is unknown or when it occurs in an uncommon location. When the histology of a lesion shows features suspicious of melanoma it should be subjected to extensive sampling, to look for the focal production of melanin and a mandatory IHC marker study helps the final diagnosis. This would help the pathologist to come to a correct diagnosis and hence prevent an unwanted contribution to patient mortality.

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