Treatment of Cervical Spine Fractures and Subluxations without the Use of Intraoperative Fluoroscopy in Resource-Limited Settings.

Background Surgical management of subaxial cervical spine injuries remains challenging. Although intraoperative fluoroscopy is usually used for intraoperative spinal level localization (SLL), it is unavailable in most developing countries. The surgeon therefore has to rely on anatomic landmarks. In our setting, in the absence of intraoperative fluoroscopy, we used the carotid tubercle for SLL. Herein we evaluate the accuracy and reliability of the carotid tubercle as a landmark during surgery for traumatic cervical spine injury. Methods This was a retrospective cohort study on 34 patients undergoing anterior cervical surgery for subaxial cervical spine fractures and/or subluxation between January 2005 and February 2011. From their medical records, the patients' sociodemographic, clinical, radiological, and operative data were retrieved and analyzed. Results Thirty-four patients were included in the study. The mean age was 36.2 years. Thirty patients were males. The mean duration between the trauma and surgical intervention was 9.6 days. Six patients were completely tetraplegic. Fourteen patients had fractures and 20 patients had subluxation. The carotid tubercle was palpable in all the 34 cases. Twenty-two (68.8%) patients had partial or complete neurologic recovery. Complete anatomic reduction was achieved in 30 cases. One case of slight malalignment of the plate was observed. No case of significant deviation nor penetration of the screw into the vertebral canal was found. One patient died. Conclusions Carotid tubercle, a palpable intrinsic marker, is an attractive anatomic landmark for SLL during surgeries for traumatic spine injuries in resource-limited settings.

Complications of arteriovenous fistula for hemodialysis: an 8-year study.

BACKGROUND: To assess the frequency and characteristics of complications of arteriovenous fistula (AVF) and their effect on fistula outcome. METHODS: We retrospectively reviewed 628 AVFs constructed from November 2002 to October 2010 to record the complications and their management options. The association between age, sex, comorbidities (HIV, hypertension, and diabetes), fistula type, and complications was sought. RESULTS: Most patients were males (73.7%). The mean age was 45.3 years. Comorbidities seen included diabetes mellitus (22.12%), hypertension (83.12%), and HIV infection (9.87%). AVFs constructed were mainly radiocephalic (68%) and brachiocephalic (24.9%). The median follow-up period was 275 days. The cumulative patency rate was 76% and 51% at 1 year and 2 years, respectively. Altogether, 211 complications occurred in 16% of the AVFs. Among them, 36.96% were severe, 25.11% moderate, and 43.91% minor. With respect to the time of occurrence, 63.98% were late complications, 12.79% immediate, and 23.22% early. Aneurysms, failure to mature, and thrombosis were the most frequent complications occurring in 26.54%, 14.69%, and 12.79% of cases, respectively. The management options for the complications included the creation of a new access in 36.96%, a temporary catheter before a new AVF in 10.52%, and nonoperative management in 43.12%. We found no adverse effect of comorbid factors such as diabetes mellitus (χ(2) = 3.58, P > 0.05) or HIV-positive status (χ(2) = 0.64, P > 0.05) on the complication rate. CONCLUSION: This study shows an overall frequency of complications of 16%. These results show the potential for low complication rate of AVF in selected population.

[Central nervous system tumours in Cameroon: histopathology and demography]. / Les tumeurs du système nerveux central au Cameroun: histopathologie, démographie.

UNLABELLED: Tumours of the central nervous system (CNS) have not received much scientific attention in sub-Saharan Africa, especially in the central African zone. The aim of this study was to determine the relative frequency and different histologic types of CNS tumours seen in the neurosurgery units of Cameroon, a multiethnic country of central Africa. This retrospective study covers the decade from January 1996 through December 2006 in the three neurosurgery departments in Cameroon, at the Yaoundé General Hospital, the Yaoundé Central Hospital, and the Douala General Hospital. INCLUSION CRITERIA: All cases undergoing surgery in these units for a histologically-confirmed CNS tumour. There were 231 cases with complete files, accounting for 6.3% of total admissions in the various units. Patients' mean age was 46.3+/-20.6 years (range: 2 weeks to 74 years); the male/female ratio was 0.8. Paediatric patients made up 15.1% (n=35) of the population while adults comprised 84.9% (n=196). In all, 74.9% (n=173) of the tumours were intracranial and 25.1% (n=58) spinal; 167 (72.3%) were the primary site and 64 (27.7%) metastatic. The average age of patients with metastatic tumors was 42+/-18.5 years compared with 36.5+/-17.8 years for cases with primary tumors. Primary tumors were malignant in 34.2% (n=12) of the children and benign in 65.8% (n=23); among adults 22.7% (n=30) were malignant and 77.3% (n=102) benign. Meningiomas were the most frequent tumours in our series, with 56 (24.2%) cases, followed by 42 astrocytomas (18.1%). Most patients were younger than 55 years. In conclusion, CNS tumors occurred mainly before the age of 55 years and had a slight predilection for girls and women. Meningiomas were the most frequent tumors in adults while astrocytomas were more prevalent in children.

Neurinomes et neurofibromes spinaux diagnostic et resultats du traitement chirurgical a Yaounde

Description les neurinomes et neurofibromes spinaux restent très peu étudiés en Afrique sub-saharienne. Objectif rapporter les résultats du traitement chirurgical des neurinomes et neurofibromes spinaux à Yaoundé. Méthodes étude rétrospective menée à l'Hôpital Général et à l'Hôpital Central de Yaoundé, du 1er Janvier 1995 au 1er Janvier 2005. Critères d'inclusion: dossier médical comprenant les résultats de l'examen clinique pré et post opératoire, ceux des examens neuroradiologiques et histopathologiques, le compte rendu opératoire. Un suivi post-opératoire minimal de six mois. Le résultat fonctionnel été évaluée par l'échelle de Karnofsky. Résultats sur 62 patients opérés d'une tumeur intrarachidiennes, 12 (19,35 %) ont été sélectionnés (neuf neurinomes, deux neurofibromes, un neurofibrosarcome). L'age moyen était de 40,66 ans ±13,20, le sex ratio 0,71. La durée moyenne de symptômes avant le diagnostic était de 17,83 mois ± 5,81, extrêmes 6 et 28 mois ; le signe d'appel le plus fréquent était la radiculalgie (six cas). Cinq patients étaient paraplégiques. Le score de Karnofsky moyen préopératoire était de 50,00 ±12,79 et de 70,83±23,53 en postopératoire. Le siège tumoral était cervical (quatre cas), dorsal (six cas), lombaire (deux cas). La tumeur était extradurale dans six cas, intra durale quatre, intra et extradurale deux cas. L'exérèse était macroscopiquement complète dans neuf cas, partielle dans trois. Cinq patients ont connu une amélioration permettant une réinsertion professionnelle. Conclusion le diagnostic des neurinomes et neurofibromes reste tardif dans notre environnement, ce qui limite le résultat chirurgical

[Neurologic disturbances in human immunodeficiency virus carriers in Yaoundé]. / Troubles neurologiques chez les porteurs du virus d'immunodéficience humaine à Yaoundé

Neurological manifestations are frequent with the acquired immunodeficiency syndrome (AIDS). They can be seen at the onset of the illness but more often they are found during its terminal phase. The aim of this study is to describe the neurological complications observed in AIDS as well as the evolution in the intensive care unit of the Yaounde General Hospital, Republic of Cameroon. This prospective study was carried out during a two-year period at the intensive care unit. All patients who were HIV-positive and who presented a neurological disorder diagnosed during the interrogation and clinical examination were included in this study. In these patients, the following paraclinical examinations were performed: ocular fundi, CD4 lymphocytes titre, toxoplasmosis serology, lumbar tap, and cerebral scan. A diagnosis was made and the patients were treated accordingly. The appreciation of the evolution was done in relation with the clinical state and the mortality observed in the service. We recruited 51 patients in all, aged 38 years on average (+/- 7 years). There were 31 women and 20 men. The neurological disorders observed were 26 states of coma, 14 agitations with mental confusion, 6 meningitis syndromes, 5 hallucinations. The titre of CD4 showed an average of 146/mm3 (+/- 12). Toxoplasmosis serology was positive for 6 patients. The cerebrospinal fluid revealed 2 cases of purulent meningitis. The ocular fundi showed 5 cases of papillary oedema. The cerebral scan showed 8 cases of cerebral abscess, 4 cases of cerebral tumour and 6 cases of cerebral toxoplasmosis. These paraclinical findings have enabled us to establish the following classification of the patients: cerebral tumors (n=4); bacterial meningitis (n=2); aseptic meningitis (n=10); cerebral toxoplasmosis (n=6); sub-acute encephalopathy (n=21); cerebral abscess (n=8). These patients were treated according to the diagnosis. The clinical evolution was marked by recovery in 14 patients with improved clinical state and by mortality in 34 patients. Many neurological disorders exist in HIV infections. These complications vary according to the stage of the illness. They are caused either by opportunistic infections, by tumours or by the virus itself. The most frequent complication in our service is sub-acute encephalitis, which induces coma. This is due to the fact that the intensive care unit receives terminal patients coming from other services. This late recruitment of patients also explains the high mortality rate.