A Review of the Current Management of Intracranial Infections of Neurosurgical Importance.

Surgically treated intracranial infections are among the common disease entities seen in neurosurgical practice. Several microbiological agents such as bacteria and fungi have been identified as responsible for intracranial infection. It affects all age groups, though microbial agents and risk factors vary with age. Presentation is non-specific and it requires a high index of suspicion, especially with a background febrile illness such as in the setting of poorly-treated meningitis and immunosuppressive conditions such as retroviral illness. Contrast-enhanced magnetic resonance imaging (MRI) scan is the diagnostic tool of choice; it helps to confirm the diagnosis and exclude other ring-enhancing lesions such as glioblastoma and metastatic brain tumours. Treatment involves medical and/or surgical treatment with clear indications. Surgical treatment includes the drainage of abscess via a twist drill or burrhole craniostomy, and craniotomy for recurrent cases. The advances recorded in the evolution of antibiotics and neuroimaging have helped to improve the outcomes of these patients with intracranial infection.

Les infections intracrâniennes traitées chirurgicalement font partie des entités pathologiques courantes rencontrées en pratique neurochirurgicale. Plusieurs agents microbiologiques tels que les bactéries et les champignons ont été identifiés comme responsables des infections intracrâniennes. Cela affecte tous les groupes d'âge, bien que les agents microbiens et les facteurs de risque varient avec l'âge. La présentation est non spécifique et nécessite un haut degré de suspicion, surtout en présence d'une maladie fébrile sous-jacente, comme dans le cas d'une méningite mal traitée et de conditions immunosuppressives telles que l'infection rétrovirale. L'imagerie par résonance magnétique (IRM) avec contraste est l'outil diagnostique de choix ; elle aide à confirmer le diagnostic et à exclure d'autres lésions à rehaussement annulaire telles que le glioblastome et les tumeurs cérébrales métastatiques. Le traitement implique un traitement médical et/ou chirurgical avec des indications claires. Le traitement chirurgical comprend le drainage de l'abcès par une trépanation ou une craniostomie à trou de trepan, et la craniotomie pour les cas récurrents. Les progrès enregistrés dans l'évolution des antibiotiques et de la neuro-imagerie ont contribué à améliorer les résultats de ces patients atteints d'infections intracrâniennes. MOTS-CLÉS: intracrânien, infection, abcès, antibiotiques, chirurgie.

Histomorphological assessment of non-neoplastic renal diseases at autopsy: an institutional experience in Southwestern Nigeria.

Background: Autopsy remains an invaluable resource for medical education and establishing diagnosis of diseases that were missed prior to death. Many patients on admission in hospitals suffer kidney diseases that may contribute to their morbidity and/or mortality. The kidneys from autopsies provide opportunity to diagnose and understand some of these non-neoplastic renal lesions. This study aimed to present the frequency of non-neoplastic renal diseases at autopsy. Methods: We conducted a five-year retrospective review of post-mortem records of deceased who had autopsy. Data such as age, sex, cause of death, and kidney lesions were extracted from the post-mortem records and clinical details were gotten from the clinical summaries in the autopsy reports. The kidneys were examined for pathological findings that were then classified into glomerular, tubulointerstitial (tubulointerstitial nephritis and other tubular lesions such as tubular necrosis, casts and fibrosis) and vascular lesions. Results: A total of seventy (70) cases met the inclusion criteria with 91.4% having significant non-neoplastic renal lesions. The mean age of the deceased was 57.7years (18years - 91years). Males accounted for 65.7% of the cases. Glomerular lesions were seen in 84.3% of the cases, tubulointerstitial nephritis in 41.6% of cases, vascular lesions were seen in 30% of the cases and other tubular lesions (such as stones, casts and tubular necrosis) were seen in 52.9% of the cases. Cardiovascular diseases and infections were the major causes of death in these patients, accounting for 40% and 27% respectively. Renal diseases were attributed to immediate cause of death in 10% of the cases. Conclusion: The kidney at autopsy provides a valuable renal pathology educational tool, as a wide range of medical renal lesions can be seen from kidneys examined at post mortem.

Histopathological profile of childhood thyroid carcinoma in Ibadan, Southwestern Nigeria.

Background: Thyroid carcinoma is a common endocrine malignancy. It is however rare in childhood and often occurs as a result of radiation exposure or inherited genetic mutations. Most childhood thyroid carcinomas are well differentiated. There are very few epidemiological studies of this disease in Nigeria and our study aimed to determine the frequency in a subset of our population. The study aimed to determine the prevalence and histopathological characteristics of childhood thyroid carcinoma in our environment. Methods: This was a retrospective review of histopathologically diagnosed thyroid carcinoma in children less than 18 years of age in the Department of Pathology, University College Hospital, Ibadan over a 40-year period. Histopathological diagnosis, age, sex and other relevant clinical information were extracted from the hospital records and surgical pathology records of the department. All cases of patients under18 years old had their slides re-examined and reclassified by two pathologists according to the World Health Organization histopathological classification of thyroid tumours. Results: There were 25 cases of thyroid carcinomas seen in children within the study period. Papillary thyroid carcinoma was the most common, accounting for 80% of the cases. Follicular carcinoma accounted for 12%, and medullary and anaplastic carcinoma accounted for 4% each. The mean age at presentation was 13 years. There was a female preponderance with females accounting for 60% of cases. Tumours with distant metastasis made up 20% of the cases. Conclusion: Childhood thyroid carcinomas are rare in our environment, with a minority of cases presenting with metastases.