Abdominopelvic Ultrasonography Research Articles

Span of spleen is associated with disability status in multiple sclerosis: a cross-sectional abdominopelvic ultrasonography study

Characteristics of livers and spleens of people with multiple sclerosis (pwMS) could constitute good biomarkers of MS-related characteristics such as the disability status. To test the hypothesis “the gross anatomical features of livers and spleens, are not similar between pwMS with different disease characteristics” a cross-sectional study was conducted on pwMS seen at the Isfahan MS clinic, Iran, from February until December 2023. Definitive, otherwise-healthy, pwMS were enrolled after an initial laboratory evaluation. Presence/absence and grading of non-alcoholic fatty liver disease (NAFLD) and the span of spleen were determined by a radiologist using high-resolution abdominopelvic ultrasonography. 193 pwMS (160 women) were enrolled. Of whom, 143 (74.1%) were receiving first-line disease-modifying therapies (DMTs), 24 (12.4%) fingolimod, and 26 (13.5%) rituximab. The span of spleen was negatively associated with EDSS (adjusted β [SE] − 4.08 [1.52], p < 0.01), as well as 6 m-CDW (adjusted β [SE] − 6.94 [3.56], p = 0.05), unlike age, DMTs, and MS duration (all with p > 0.05). Receiver operating characteristic analysis showed, spleen span performs significant but poor in discrimination of EDSS > 1 from EDSS = 1 (area under curve [AUC] 0.62, SE 0.05, p < 0.01), yet, significant and fair in discrimination of presence from absence of 6 m-CDW (AUC 0.72, SE 0.06, p < 0.01). Other findings were unremarkable. Further longitudinal, prospective studies are warranted to confirm whether smaller spleens are predictive of higher disability accrual rate in pwMS. Particularly, findings require further validation in untreated/treatment-naïve pwMS, and ones with higher EDSS scores.

Male urethral stricture disease in a tertiary hospital in Port Harcourt, Nigeria: a five-year review of features, management and outcome.

Introduction: The aim is to assess the early impact of the current increased use of transurethral endoscopic procedures and emerging technologies on the management of urethral stricture disease (USD) in adult males at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria. Material and Methods: The design of the study was cross-sectional and descriptive. Secondary data of patients treated between 01/6/2017 to 30/6/2022, with confirmed diagnosis of USD were used. Their registration numbers were used to access their records at the Health Records Department of the Hospital. Information obtained included sociodemographic data, aetiology, clinical features, types, sites and diagnostic tests of male USD, , uroflowmetry, urethral, and abdominopelvic ultrasonography, cystourethrography results, treatment methods, outcomes, complications and co-morbidities of USD. Data obtained were analyzed with simple statistics and presented. Results: Of 10,450 Urology patients 245 had USD. Data on 224 were found and analyzed. Their age profiles in years were mean, 45.7±18.6; age range 10-95. Married were 174 (77.68%). Urethral strictures were post inflammatory 126(56.25%); post traumatic 43.75%; bulbar,73(32.59%); bulbomembranous23.22%; posterior urethral 52(23.21%); penile 34(15.18%); and pan urethral 13, (5.18%). At presentation, 105 (46.88%) were hypertensive; 40.2% had UTI with Gram-negative bacilli. Recurrence of strictures occurred 6 months to one year after DVIU; 2 months to 6 years after urethroplasty. Non-compliance with schedules and follow-p occurred in 111 (49.55%) patients. Conclusion: USD prevalence was 24/1000 urology patients. UTIs were probably healthcare and prolonged catherization associated. Screening/review of service processes warranted. Lack of validated tools for measurement of outcome or dependent treatment variables made comparative studies unrealistic.

A rare case of uterine lipo-leiomyoma in a 63-year-old Nigerian woman; a case report

Background: Lipo-leiomyoma accounts for about 0.03%-0.2% of uterine tumours. The aetiology of lipo-leiomyoma is unclear, with some suggesting fatty metamorphogenesis and others involving growth factors and oestrogens. Radiological evaluation and histology are necessary for definitive diagnosis. If asymptomatic, no treatment is needed, but surgical resection is performed in symptomatic patients. Case Presentation: This was a case of a 63-year-old Nigerian woman who experienced pelvic pain and heaviness for a year, worsening pelvic pain and distension, and post-menopausal bleeding. Abdominal examinations revealed a pelvic mass, vaginal examination showed no vaginal and cervical lesions, while abdominopelvic ultrasonography (USS) unveiled a hyperechoic mass in the posterior uterus. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathological assessment of the samples showed a confirmatory diagnosis of uterine lipo-leiomyoma. Conclusion: Lipo-leiomyoma is a rare, distinct uterine pathology that should be considered a differential diagnosis in post-menopausal women with vaginal bleeding. Total abdominal hysterectomy and bilateral salpingo-oophorectomy are recommended for menopausal women with symptomatic disease to prevent recurrent anaemia and also remove possible sites of the tumour even as the patient is unlikely to conceive again. Histopathological evaluation is crucial for post-menopausal women with coexisting bleeding per vagina.

Endometrial carcinoma with co-existing granulosa cell tumour in a post-menopausal woman: a case report

Background: Granulosa cell tumors (GCT) of the ovary are extremely infrequent tumors accounting for about 3% of the entire ovarian malignancies with a very high rate of recurrence. Due to its ability to secrete estrogen unopposed, it can give rise to endometrial cancer thus leading to the coexistence of the two tumors on rare occasions. Case presentation: We present here, the case of a 58-year-old post-menopausal Nigerian woman with GCT coexisting with endometrial carcinoma. She presented with abdominal pain, weakness, and post-menopausal vaginal bleeding. Examination revealed an irregular 30-week size abdominopelvic mass while an abdominopelvic ultrasonography showed a right ovarian mass and multiple uterine fibroids. However, the diagnosis of GCT coexisting with endometrial carcinoma was histologically confirmed. She has been clinically stable for ten months post-surgical intervention and completion of adjuvant chemotherapy (Cisplatin [75mg/m2] and Docetaxel [75mg/m2]). Conclusion: Although rare, GCT can exist synchronously with endometrial carcinoma. This should form an important differential diagnosis in a post-menopausal woman with bleeding par vaginum as this is its most important clinical presentation. Total abdominal hysterectomy with bilateral adnexectomy should be done in older patients with GCT. Additionally, adjuvant chemotherapy may be of tremendous benefit to diagnosed patients.

Diagnostic dilemma in a patient with history of medullary thyroid carcinoma and abnormal serum liver enzymes; a case report with six years follow up

BackgroundMedullary thyroid carcinoma (MTC) is a neuroendocrine tumor that originates from parafollicular C-cells. Calcitonin (Ctn) and carcinoembryonic antigen (CEA) are useful biomarkers for monitoring MTC cases.Case presentationHere, we describe a 48-year-old woman, who presented in 2014 with bilateral thyroid nodules. Report of fine needle aspiration was suspicious for MTC; initial laboratory evaluation showed serum Ctn level of 1567 pg/mL. After excluding type 2 multiple endocrine neoplasia syndrome clinically, total thyroidectomy and neck lymph node dissection were performed. The final histopathological diagnosis was right lobe MTC with neither vascular invasion nor lymph node involvement. On regular follow-up visits, Ctn and CEA levels have been undetectable, and repeated cervical ultrasonographic exams were unremarkable from 2014 to 2021. As liver enzymes became elevated in 2016, the patient was further evaluated by a gastroenterologist. Abdominopelvic ultrasonography revealed a coarse echo pattern of the liver parenchyma with normal bile ducts. A liver fibroscan showed a low fibrosis score (7kPa). The patient was recommended to use ursodeoxycholic acid. According to the progressive rise of liver enzymes with a cholestatic pattern in October 2020, a liver biopsy was performed that showed tiny nests of neuroendocrine-like cells with a background of primary biliary cholangitis (PBC). Immunohistochemical stainings were positive for chromogranin A (CgA), and synaptophysin and negative for Ctn, CEA, and thyroglobulin. Further imaging investigations did not reveal any site of a neuroendocrine tumor in the body. Considering normal physical exam, imaging findings, as well as normal serum levels of Ctn, CEA, CgA, and procalcitonin, the patient was managed as a PBC.ConclusionIn follow-up of a patient with MTC, we reported progressively increased liver enzymes with a cholestatic pattern. Liver biopsy revealed nests of neuroendocrine-like cells with a background of PBC, the findings that might suggest acquiring neuroendocrine phenotype by proliferating cholangiocytes.

Diagnostic approach in 46, XY DSD: an endocrine society of bengal (ESB) consensus statement.

46, XY difference/disorder of sex development (DSD) is a relatively uncommon group of heterogeneous disorders with varying degree of underandrogenization ofmale genitalia. Such patients should be approached systematically to reach an aetiological diagnosis. However, we lack, at present, a clinical practice guideline on diagnostic approach in 46, XY DSD from this part of the globe. Moreover, debate persists regarding the timing and cut-offs of different hormonal tests, performed in these cases. The consensus committee consisting of 34 highly experienced endocrinologists with interest and experience in managing DSD discussed and drafted a consensus statement on the diagnostic approach to 46, XY DSD focussing on relevant history, clinical examination, biochemical evaluation, imaging and genetic analysis. The consensus was guided by systematic reviews of existing literature followed by discussion. An initial draft was prepared and distributed among the members. The members provided their scientific inputs, and all the relevant suggestions were incorporated. The final draft was approved by the committee members. The diagnostic approach in 46, XY DSD should be multidisciplinary although coordinated by an experienced endocrinologist. We recommend formal Karyotyping, even if Y chromosome material has been detected by other methods. Meticulous history taking and thorough head-to-toe examination should initially be performed with focus on external genitalia, including location of gonads. Decision regarding hormonal and other biochemical investigations should be made according to the age and interpreted according to age-appropriate norms Although LC-MS/MS is the preferred mode of steroid hormone measurements, immunoassays, which are widely available and less expensive, are acceptable alternatives. All patients with 46, XY DSD should undergo abdominopelvic ultrasonography by a trained radiologist. MRI of the abdomen and/or laparoscopy may be used to demonstrate the Mullerian structure and/or to localize the gonads. Genetic studies, which include copy number variation (CNV) or molecular testing of a candidate gene or next generation sequencing then should be ordered in a stepwise manner depending on the clinical, biochemical, hormonal, and radiological findings. The members of the committee believe that patients with 46, XY DSD need to be approached systematically. The proposed diagnostic algorithm, provided in the consensus statement, is cost effective and when supplemented with appropriate genetic studies, may help to reach an aetiological diagnosis in majority of such cases.

Bladder Calculus in a Male Child with Features of Urethral Stricture: Radiologic Findings and a Case Report

Urinary lithiasis is a very common urological disease but bladder lithiasis is very uncommon and account for about 5% of urolithiasis and most frequent urolithiasis in pediatric age. Giant calculi can present with few symptoms, it is very important to exclude lower urinary tract obstruction as the cause, but significant cases may come without obstruction. The male sex is more affected than the female sex. This is a case of an 11 year old male child with complaint of suprapubic pain, dysuria, hematuria, decreased urinary stream and increased frequency of micturition for more than three years prior to presentation. The patient had plain abdominal radiograph showing the region of the kidneys, ureters and urinary bladder (KUB) with an abdominopelvic ultrasonography. These demonstrated a calculus in the urinary bladder measuring about 70mm x 50mm in mediolateral and craniocaudal dimensions. The patient is yet to have a surgical extraction (extraperitoneal cystolithotomy) with of the entire calculus. We present a case of a giant calculus in a child due to its rare nature and peculiar presentation.

Mayer-Rokitansky-Küster-Hauser Syndrome

The association of renal abnormalities with Mullerian anomalies is well recognized and assessment of the renal tract forms part of the routine assessment of patients presenting with Mullerian anomalies. This is a case of a 20-year-old nulliparous female who had abdominopelvic ultrasonography on account of primary amenorrhea showing bilateral ectopic kidney fused in the pelvis, complete absence of the uterus, the cervix, and the upper part of the vagina; while normal sized ovaries seen. These were confirmed on computed tomography (CT). Renal CT angiograms showed a renal artery arising anteriorly from the abdominal aorta just above its bifurcation into the common iliac arteries. An interesting feature in this patient was the existence of the median sacral artery in the blood supply of the fused pelvic kidney. No skeletal anomalies were visualized in dorsolumbar spine or pelvis.

Intraoperative Evaluation of a Serous Cystadenofibroma of the Fallopian Tube in a 13-Year-Old Female

Background: Cystadenofibromas (CAFs) are defined as benign mixed mullerian tumors. They are diagnosed mainly in the ovary. Nonetheless, extraovarian locations, such as endometrium, uterine cervix, fallopian tube, and parasalpinx, were reported. Clinical course is commonly asymptomatic, and tumors are often diagnosed on histology after adnexal cyst surgery for benign indications. Case: A 13-year-old female was admitted into our emergency room with acute lower right abdominal pain as her main complaint. Abdominopelvic ultrasonography showed a right adnexal unilocular cyst with small papillary projections on the inner wall of the cyst, with no apparent solid component. Result: During laparoscopy, two cystic masses dependent on the distal region of the right fallopian tube were seen. After fluid aspiration of the first cyst, capsule was opened to see the nodular formations (papillary projections) previously described by ultrasonography. Right salpingectomy was performed due to high suspicion of a borderline tumor. Histopathologic diagnosis was compatible with a serous CAF. Conclusion: In our case we tried an intraoperative evaluation of the inner surface of the cyst, observing papillary projections that were regular and well adhered to their wall. However, microscopic pathology assessment of the tumor is mandatory to have definitive diagnosis. Surgical treatment, especially in child and youth population, should be conservative and adnexectomy should be avoided. Laparoscopic approach is often successful and can be considered in these cases. Although previous published cases were diagnosed in an incidental manner, our case highlights the importance of a thorough intraoperative assessment of adnexal tumors in child and adolescent patients.

Stone cobra: “Adult” left single system ureterocele with 139 calculi-case report and review of the literature

A 35yr old man old with no previous major clinical issues presented with a 2years history of radiating left flank pain and dysuria. Abdominopelvic ultrasonography and an intravenous urography confirmed a bladder stone and a left single unit ureterocele harboring multiple stones showing as a typical “Cobra head” with resultant hydronephrosis.

Value of ultrasonography and the Raja Isteri Pengiran Anak Saleha Appendicitis score in the diagnosis of acute appendicitis.

The diagnosis of acute appendicitis is a clinical challenge. Clinical scoring systems and radiological examinations are used to assist in diagnosis. We reviewed 106 patients between January 2016 and January 2018 who presented with right iliac fossa pain and underwent appendectomy. Their Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scores were calculated and abdominopelvic ultrasonography (USG) was performed before they were operated with a prediagnosis of acute appendicitis. RIPASA scores and USG findings were compared to the histopathological results of appendectomy specimens. The histopathological examinations showed that all of the 100 (94.3%) patients whose RIPASA scores were 7 and more had acute appendicitis and the six (5.7%) patients whose scores were less than 7 had no appendicitis. When the appendectomy specimens of the 70 patients who had been diagnosed with acute appendicitis with USG were examined histopathologically, 69 (98.6%) patients were confirmed to have acute appendicitis. Acute appendicitis was found in 18 (81.8%) of the 22 patients whose appendixes could not be visualized with USG. Acute appendicitis was found in eight (88.9%) of the nine patients who had been reported normal with USG. RIPASA scores should be calculated for all patients who are suspected of having acute appendicitis and for those with a RIPASA score of 7 and more, surgery should be highly recommended without USG.

Role of Interleukin-10 and Abdominopelvic Ultrasound as a Potential Predictor of Disease Severity in Dengue Hemorrhagic Fever.

IntroductionDengue viral infections are a major cause of morbidity and mortality in tropical/subtropical countries. Early and prompt detection of dengue hemorrhagic fever (DHF), though challenging, is helpful to identify an individual that would benefit from intensive therapy.ObjectiveThe goal of this study was to determine the plasma interleukin-10 (IL-10) levels in DHF patients at four to seven days of disease onset and 24 hours after the first sample. We also aimed to determine the association of plasma IL-10 levels and abdominopelvic ultrasound findings.MethodsA total of 50 registered DHF patients aged 15 to 50 years were recruited. Plasma IL-10 concentration measurements and abdominopelvic ultrasounds were performed. Patients were also categorized based on ultrasound grading I to IV (based on severity). Outcomes were described as recovery and shock. Platelet count and hematocrit percentages were also recorded.ResultsPlasma IL-10 levels were elevated in DHF patients and associated with fatal outcomes (p = 0.00). Binary regression-coefficient showed the direct effect of high levels of plasma IL-10 on the fatal outcome of patients 24 hours after the first sample (p = 0.04). Disease severity was predicted by a positive correlation between ultrasound grades and outcomes (p = 0.00). Spearman’s correlation coefficient found a highly significant inverse relationship between plasma IL-10 levels and platelet count after 24 hours (p = 0.01). However, a significant positive relationship was observed between elevated plasma IL-10 levels and hematocrit percentage after 24 hours (p = 0.01).ConclusionElevated plasma IL-10 levels and abdominopelvic ultrasonography are promising potential predictors of disease progression and fatal outcome in DHF patients.

SAT-304 Unexplained Asymptomatic Hyperestrogenism in Central Precocious Puberty Patient Treated with Gonadotropin Releasing Hormone Agonist

In Central precocious puberty(CPP), the gonadotropin-releasing hormone(GnRH) agonist competes with LHRH in the pituitary gland to desensitize and downregulate the response of gonadotropin-releasing hormone receptors, effectively inhibiting the secretion of sex hormones in the gonad to prepubertal levels. During the treatment, the bone age progression is slowed, the progression of secondary growth is stopped, and the secretion of sex hormones is maintained as prepubertal levels. We report a case of CPP patient who was treated with GnRH agonist, but abnormally elevated in estradiol level without changes in FSH and LH levels, and slowly normalized without any other abnormal clinical symptoms or laboratory findings. A 5 year and 10 months old girl visited our clinic with breast development which was examined as Tanner stage 2-3. Anthropometric datas were as follows: Her height was 127.3 cm(100th percentile), body weight was 29kg(100th percentile), and BMI was 17.9 kg/cm2. Her bone age was asessed to be 9.7 years by TW3 method. In the abdominopelvic ultrasonography, her uterus showed a pubertal status and no other abnormal findings were noted. LHRH stimulation test showed a pubertal response (peak LH level: 12.1 IU/L after 30min). She was confirmed as central precocious puberty, but brain MRI could not be perfomed due to refusal of the patient’s parents. Suppressive treatment was initiated with leuprorelin acetate 3.75mg(Lorelin depo, Dongkuk pharm). There was no further progression of secondary sexual characteristics after the treatment, and we noticed the downregulation of gonadotropin(FSH,LH) and estradiol in initial follow up hormonal assessment. However, second follow up study which was perfomed after 6 months of the treatment showed a feature of peripheral precocious puberty (FSH:1.0 IU/L(normal<2), LH:0.5 IU/L(normal<0.3), Estradiol: 68.6 pg/mL(normal<10)). There was no changes in secondary sexual characteristics of the patient, and no specific abnormal finding was found in her pelvic ultrasonography. On consecutive serial follow up studies, only the estradiol level was elevated gradually, and reached 162.2 pg/mL after 12 months of the treatment. There was no estrogenic effect such as acceleration of height gain, progression of secondary sexual characteristics, uterine enlargement, or rapid bone age progression. The duration of elevated hormonal status of the estradiol was nearly 48 months. Bone age was advanced from 9.7 to 10.4 years in this period. No abnormal skin lesion including café au lait spot was appeared. However, after this period, estradiol level was gradually decreased and normalized on consecutive follow up studies. In conclusion, estrogen elevation could be shown during the GnRH agonist treatment in CPP patients, however, there is an uncommon possibility of rising and normalizing estrogen levels without evidence of disinhibition in being-treated CPP patients.

SAT-303 Combined Treatment of Gonadotropin Releasing Hormone Agonist and Recombinant Human Growth Hormone in Cental Precocious Puberty Patient with Underlying Leri Weill Dyschondrosteosis

Leri-Weill dyschondrosteosis (LWD) is a rare genetic disorder of bony growth characterized by abnormal shortening of the forearms and lower legs, abnormal misalignment of the wrist (Madelung deformity), and associated short stature. As a result of shortened leg bones, LMD patients typically have short stature. Additional symptoms and severity can vary greatly from one person to another, even among members of the same family. LWD is caused by a heterozygous mutation in the short stature homeobox-containing (SHOX) gene or its regulatory elements (enhancers) located on the pseudoautosomal region 1 (PAR1) of the sex chromosomes. There are a number of reports about GH-treated SHOX-deficient patients such as LMD, idiopathic short stature, and Turner syndrome, however, in this report, we would like to introduce a rare case with underlying LWD and central precocious puberty, who was treated by combined therapy of gonadotropin releasing hormone (GnRH) agonist and recombinant human growth hormone (rhGH). A 8 years and 4 months old girl visited our clinic for short stature and breast development of Tanner stage 2. In physical examination, her height was 117 cm (<3rd percentile), weight was 22 kg (13th percentile), and BMI was 16.07 kg/m2. Her father's and mother's height was 165cm and 162 cm, respectively, and her midparental height was calculated as 157cm. There were no specific findings in family history. She showed high arched palate and disproportion of limbs. In radiologic studies, the patient showed Madelung deformity of both forearms and functional scoliosis, and her bone age was assessed to be 9 years 7 months by TW3 method. In laboratory findings, LHRH stimulation test showed a pubertal response (peak LH level: 12.4 IU/L after 30mins). Abdominopelvic ultrasonography revealed her uterus and ovary both as pubertal status and no other abnormal findings were noted. Therefore, we diagnosed her as LWD and sexual precocity, and the results of the molecular genetics test confirmed the suspicion of LWD. The combination treatment of GnRH agonist and rhGH was started to improve the final adult height for the patient with early onset pubescence and short stature. After 3 years and 7 months of treatment, her height was 146cm and additional growth gain was 29cm. Secondary sexual characteristics proceeded to Tanner stage IV in normal order, and menarche occured at 13 years old. No adverse event was observed. After 6 months of completion of treatment, her height was 150 cm which was thought to be near adult height. In conclusion, LMD patients typically have short stature and it has been known that rhGH treatment is effective for growth promotion in these patients. However, clinicians should be aware of the possibility of LWD and concominant diagnosis of precocious puberty, which could lessen the predicted adult height, and in that case, combined therapy of GnRH agonist and rhGH can be helpful to improve the final height.

Early outcome of pediatric pyeloplasty in kidneys with split renal function less than 10%: A prospective study of 25 cases

ObjectivesTo detect the outcome of pyeloplasty in kidneys with split renal function (SRF) less than 10% in the pediatric age group. Subjects and methodsWe prospectively analyzed the data from 25 cases of ureteropelvic junction obstruction (UPJO) candidate for pyeloplasty with SRF less than 10%. Abdominopelvic ultrasonography and diuretic renogram using technetium-99m diethylenetriamine Penta acetic acid (DTPA) were done in all cases. We studied the improvement in pelvic anteroposterior diameter (APD) postoperatively. We compared pre and postoperative SRF after six months and one year. ResultsThe median age was 24 months (3 months–11 years), male to female 2:1. The median preoperative SRF was 5% (range: 0%–10%) and the median APD of the renal pelvis was 3cm (range: 2.2–5). There was significant improvement of median APD 0.8cm (range: 0.5–1.9) (P value <0.05). There was a significant postoperative improvement in the median SRF (P-value <0.05) as the median SRF after 6 months and 1year were 21% and 20%, respectively but there was no significant difference between SRF at six months and one year (P value 0.174). ConclusionPyeloplasty provides high rates of functional success even in very poorly functioning kidneys with SRF ≤10% by DTPA renogram in pediatric age group.

The role of electrocardiogram in sex verification in a young adult with primary amenorrhea: a case report

BackgroundThe use of electrocardiogram for sex verification in adults is an emerging concept in medicine. It is feasible through the utilization of Ogunlade Sex Determination Electrocardiographic Score. The aim of this study was to use an electrocardiogram to verify the sex of a woman with primary amenorrhea.Case presentationWe report a case of a 36-year-old woman of Yoruba ethnicity who presented with primary amenorrhea. A physical examination revealed a woman with a feminine appearance characterized by long plaited hair and well-developed breasts. As part of the investigations to unravel the sex status, she had a resting standard 12-lead electrocardiogram which revealed a masculine electrocardiogram pattern with Ogunlade Sex Determination Electrocardiographic Score of 9 (T-wave pattern in lead V1, 3; ST segment in lead V2 or V3, 3; QRS rotation, 2; heart rate of 79, 1). An abdominopelvic ultrasonography done by a radiologist showed absence of uterus, fallopian tubes, and ovaries. When our patient was considered for transvaginal scan, she declined but embraced translabial ultrasound as she claimed to be a virgin. Translabial ultrasonography revealed the presence of undescended hypoplastic testes with associated testicular microlithiasis at the external inguinal rings bilaterally. Karyotyping using a blood sample revealed 46,XY and a sex-determining region Y report showed that the blood sample was positive for the SRY gene confirming the status as male. This synchronized with the initial electrocardiogram evaluation. The testes were later removed.ConclusionThis report concluded that an electrocardiogram as a cheap, readily available and non-invasive test has a role in sex verification in young adults with primary amenorrhea.

Association of Androgenetic Alopecia with Benign Prostatic Hyperplasia: A Case Control Study

Introduction: Androgenetic alopecia (AGA) is associated with increased risk of several systemic diseases and some environmental factors, however, controversies exist. Since AGA and Benign Prostatic Hyperplasia (BPH) share common pathogenesis and AGA manifests some decades before BPH onset, it may serve as an early marker of BPH.Objective: This study was conducted to know AGA and its association with BPH in men ≥20 years of age.Materials and Methods: Clinically diagnosed cases of AGA (n=176) and 117 age matched healthy controls were enrolled. All cases and controls were subjected for abdomino-pelvic ultrasonography, urinary flowmetry, fasting lipid profiles, glycemic index and body mass index. International Prostate Symptom Score (IPSS) was also assessed.Results: Among 176 patients, 120 (68.18%) had Hamilton-Norwood grade III AGA and 56 (31.82%) had grade IV-VII AGA. In both groups, 140 (79.55%) cases and 93 (79.49%) controls were aged &lt;35 years respectively. Family history of AGA was present in 108 (61.36%) cases and 2 (1.71%) controls. This observation was statistically significant with OR= 89.61 (95%CI 23.67-339.29). Three (1.7%) cases and none of the controls had prostate volume &gt;30ml. Seventeen(9.66%) cases and 4 (3.42%) controls were graded as moderately/severely symptomatic IPSS. Statistically significant association was seen between family history and early onset of hair loss (&lt;35 years) in a male sibling or parent.Conclusion: Although positive family history was associated with early onset of AGA, no association between AGA and BPH could be elicited in our study.

Echographie Pédiatrique En Pratique Hospitaliere Au Centre Hospitalier Universitaire (CHU) De Kara Au Togo

Purpose: To list pediatric ultrasound exams performed at Kara University Hospital Center in Togo and the pathologies observed. Materials and methods: This was a retrospective and descriptive study of the results of pediatric ultrasound examinations performed in the Department of Radiology and Imaging of Kara University Hospital Center. The study ran from January 1, 2013 to December 31, 2016, over a period of 3 years. Results: The frequency of pediatric ultrasounds was 5.1%. The average age of the patients was 2.16 years with extremes of 1 day to 15 years. There was a male predominance with a sex ratio of 1.4. Abdomino-pelvic ultrasound were the most represented, 92%, followed by cervical ultrasound in 2.6% of cases. Abdominal ultrasound indications were dominated by abdominal pain in 33.6% of cases, followed by palpation of abdominal mass in 15.7%. Cervical ultrasounds were motivated in 5 out of 8 cases by the cervical swelling. Abdomino-pelvic ultrasonography was pathological in 70.1% of cases. Hepatic affections were the most common abdominal abnormality in 37.8% of cases followed by splenic disorders. Hepatic lesions were dominated by European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431 444 homogeneous hepatomegaly with 63.2% of cases. Cervical ultrasound was pathological in 6 out of 8 cases. The lesions observed were mainly cervical lymphadenopathy (4 cases out of 6). Conclusion: Ultrasound is a very useful tool in the exploration of pediatric diseases. The abdominal ultrasound is the most performed and hepatic pathologies are the most common.

Mucocele of the appendix: A case report and review of literature

Mucocele represents mucinous dilation of the lumen of vermiform appendix resulting from obstruction or increase secretion. It is a rare disease with an incidence of 0.2–0.7% of all appendectomies and 8–10% of all appendiceal tumours. The clinical presentation is atypical with most cases usually asymptomatic. Mucocele of the appendix indicates dilation of the appendix lumen irrespective of the aetiology. Four types of appendiceal mucocele are defined by the cause of obstruction: retention cysts, epithelial hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. Mucocele of the appendix is a rare condition of the appendix that requires high index of suspicion for a definitive preoperative diagnosis. The treatment for appendiceal mucocele is typically surgical resection. We report a case of a 37-year-old woman with recurrent right iliac fossa pain of 20 years duration. Abdomen was full, moved with respiration with a positive pointing sign. There was marked right iliac fossa tenderness with rebound tenderness and guarding. She had an abdominopelvic ultrasonography that revealed features of acute appendicitis. She had surgery with intraoperative finding of marked distension of the appendix from the tip to the base with necrosis at the base, a right hemicolectomy was done.

Impact of transobturator vaginal tape on female stress urinary incontinence and sexual function

ObjectiveTo evaluate the effect of vaginal transobturator tape (TOT) on female stress urinary incontinence (SUI) and sexual function. Patients and methodsIn all, 145 patients with SUI underwent TOT repair using the ‘outside–in’ technique. All patients had been sexually active in the previous 6months. Patients were evaluated by history, routine laboratory investigations, cough stress test, abdominopelvic ultrasonography, and full urodynamic studies. The preoperative data assessed included: age, parity, body mass index, menopausal status, and Stamey grade of SUI. The intraoperative data assessed included: operative time, blood loss, and hospital stay; intra- and postoperative complications were also assessed. At 2weeks after discharge, patients were followed-up with a routine examination and cough stress test. After 6months’ patients were assessed by urodynamic studies, maximum urinary flow rate, post-void residual urine volume. The following questionnaires were completed before and at 6months after TOT insertion: International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), Urogenital Distress Inventory-Short Form (UDI-6), and Female Sexual Function Index (FSFI). ResultsAll sociodemographic data of the 145 patients were collected. According to ICIQ-SF scores, 122 patients were cured, 19 had improved, and four failed. There were significant improvements in the UDI-6 and FSFI scores, indicating that the women had significant improvement in their sexual life. There were six cases of urinary tract infection, five cases had a fever, and eight patients complained of groin or thigh pain postoperatively. ConclusionsCorrection of SUI using TOT appears to have a positive effect on female sexual function.