DR.AYWAK ANYONA ANGELINE

OBJECTIVE: To compare the findings of venous sonography with contrast venography in the detection of deep venous thrombosis (DVT) of the lower limbs. DESIGN: Prospective study. SETTING: The Kenyatta National Hospital, a teaching and referral hospital in Nairobi. SUBJECTS: Fifty five limbs in 44 patients with clinical suspicion of DVT were evaluated during the seven months study period (October 2002-April 2003). The ethics committee in the institution granted approval for the study and participants gave written informed consent. INTERVENTION: Venous sonography in which a three step protocol involving B-mode gray scale compression sonography, colour and colour Doppler sonography was obtained after contrast venography in patients with clinical suspicion of DVT. The ultrasound examination was done within 24 hours of the contrast venogram. RESULTS: The overall sensitivity of venous sonography was 88.9%, specificity 91.8% and accuracy 90.9%. Considering only DVT above the calf, the sensitivity improved to 100%. An alternative diagnosis was found by ultrasound in 48.6% of the negative for DVT cases. CONCLUSION: The accuracy of venous sonography as done locally is high and comparable to that in developed countries. We recommend that for patients with clinical suspicion of DVT, venous sonography be done as the initial imaging investigation and venography be reserved for those patients with equivocal or inadequate sonography results. PMID: 17886423 [PubMed - indexed for MEDLINE

OBJECTIVE: The role of Biophysical Profile Score and resistive index of the umbilical artery for monitoring pre-eclampsia patients. DESIGN: Descriptive prospective study. SETTING: Kenyatta National Hospital and Mater Hospital, Nairobi, Kenya. SUBJECTS: One hundred and ten cases during a three month period. RESULTS: Normal biophysical profile scores were found in 93 (84.5%), and 17 (17.5%) cases had abnormal scores ranging from mild to severe foetal distress. Resistive index of umbilical artery (RI-UA) were normal in 72 (66.1%) and high resistive index accounted for 33.9%. Intra-Uterine Growth Restriction (IUGR) was a prominent finding accounting for 30.5%. A positive relationship was shown to exist between IUGR and RI-UA and also with severity of hypertension with P-values < 0.05. Resistive index of umbilical artery was positively related to the duration of illness confirming its dependence on chronicity (P = 0.004). Resistive index of umbilical artery proved to be an earlier indicator of foetal compromise before any foetal distress becomes obvious. CONCLUSION: Regular obstetrical ultra sound foetal surveillance in pre-eclampsia patients is important for foetal wellbeing. Doppler evaluation of high risk patients is more sensitive test than the biophysical profile score. PMID: 16771106 [PubMed - indexed for MEDLINE]

BACKGROUND: Diagnostic radiology investigations play important roles in the management of Burkitt's Lymphoma. OBJECTIVES: To document the various radiological manifestations of Burkitt's lymphoma as seen in patients at the Kenyatta National Hospital. DESIGN: Prospective study of Burkitt's Lymphoma cases admitted to the paediatric and Ear, Nose and Throat Wards. SETTING: Kenyatta National Hospital. MAIN OUTCOME MEASURES: All histological proven cases of BL had the following documented; Age sex, tribe, geographical (province) of origin, full medical evaluation results, presenting site of tumour, radiological findings and results of chest X-ray, abdominal ultrasound occipital frontal view of the skull X-ray. computerised tomography, myelography and orthopantomograms. RESULTS: In the period between April 1991 and March 1992 this study registered 49 patients age range 2 to 14 years. These were males 34 (69%) and females 15 (31%). The commonest radiological findings was associate with intra abdominal lymphoma seen in 65.2% of the cases, the least findings associated with cervical adenopathy and pleural effusion each 3.3% of cases. Twenty (41%) of the disease was clinically confined to the facial area while radiologically 25% of these were demonstrated to extend to the abdomen as well. CONCLUSION: Disease extent on radiological examination was found to be more extensive compared to clinical evaluation alone. The observation emphasised the role of radiological investigation in the management of lymphomas in this setting.East Afr Med J. 2004 Aug;(8 Suppl):S104-10. PMID: 15617420 [PubMed - indexed for MEDLINE

The radiological features of Burkitt's Lymphoma were
assessed in 49 children with a histological diagnosis of
Burkitt's lymphoma admitted to the Kenyatta National Hospital
Paediatric wards. The commonest radiological findings were
associated with abdominal lymphomas seen in 65.2% of the
cases. The least findings were associated with cervical
adenopathy seen in 3.3% and a similar number had pleural
effusion. Disease extent on radiological evaluation was
greater than as assessed clinically alone. For instance,
while 20 cases were clinically found to have disease confined
to the facial bones, on radiological evaluation 5 of the 20
cases were found to have Burkitt's Lymphoma deposits in the
abdominal viscera besides the facial lesions. The age
range was 2-14 years with the incidence falling rapidly after
10 years. The male female ratio was 2.3 : 1. Peak
incidence was at 5 - 7 years. The highest incidence was found
among tribes residing in endemic malarial areas. The Luo had
the highest incidence with 19 cases (38.8%) followed by the
Luhya with 11 cases (22.4%).