[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.

[Results of surgical management of spinal neurinomas and neurofibromas at Yaounde]. / Resultats du traitement chirurgical des neurinomes et neurofibromes spinaux a Yaounde.

BACKGROUND: Spinal neurinomas and neurofibromas are poorly studied in Sub-Saharan Africa. AIM: The objective of this study was to report the results of the surgical management of these tumours in Yaoundé. METHODS: This was a retrospective study done at the Yaoundé General and Yaoundé Central Hospitals from the 1st of January 1995 to the 1st of January 2005. The inclusion criteria: medical files which had the results of pre and post operatory clinical examinations, neuroradiologic and histopathologic examinations, the post operatory report. The follows up of at least six months. The functional outcome was evaluated using the Karnofsky scale. RESULTS: Of the 62 patients operated for an intraspinal tumor, 12 (19.35%) were selected (nine neurinomas, two neurofibromas, one neurofibrosarcoma). The mean age was 40.66 years +/- 13.20 with a sex ratio of 0.71. The average duration of symptoms before the diagnosis was 17.83 months +/- 5.81; the most frequent symptom was radicular pain (six cases). Five patients were paraplegic. The average Karnofsky score was 50.00 +/- 12.79 before surgery and 70.83 +/- 23.53 after. The situation of the tumor was cervical (four cases), dorsal (six cases) and lumbar (two cases). The tumor was extradural, intradural, intra and extradural in six, four and two cases respectively. Tumor excision was macroscopically complete in nine cases and partial in three. Five patients were well enough after treatment to continue their professional activities. CONCLUSION: The diagnosis of neurinomas and neurofibromas are late in our environment, resulting to poor surgical results.

Relative rates and features of musculoskeletal complications in adult sicklers.

The purpose of this study was to prospectively look for the relative rates and features of musculoskeletal complications in a sample of adult homozygous SS sicklers in Yaoundé. During a 3-year period, known homozygous SS sicklers aged sixteen years or more, with suspicion or evidence of locomotor system disease, including leg ulcer, were consecutively investigated through complete medical history, clinical examination, full blood count, C-reactive protein, standard radiographs of the area of complaint, and, when necessary, CT scan and pus analysis. Those patients with no definite diagnosis were excluded. The study group comprised 84 patients aged 16 to 51 years (mean age: 22 years), with a male/female ratio of 0.75. Four of them (4.5%) were older than 40 years. Thirty five (41.6%) presented a total of 50 lesions of aseptic osteonecrosis, which were located in the hips in 25 cases (50%), in the lumbar spine in 20 cases (40%), in the humeral head in four cases (10%) and in the talar body in one case. The hip necrosis was grade I in 6 cases, grade II in four, grade III in 11 and terminal in four. Multiple sites of necrosis were observed in six patients. Nineteen (22.6%) of the sicklers came on with 36 malleolar ulcers, more frequently in males (sex ratio: 5/1) and 28 (78%) located on the medial side. Fifteen sites of osteomyelitis were noted in 14 patients (17.8%) and septic arthritis in six (7%). Less frequent complications were impingement syndrome, gout osteoarthropathy, stress fracture, subtalar fusion, knee osteoarthritis, tendonitis of the anterior tibialis, and recurrent dislocation of the patella. All patients were managed conventionally, except for advanced aseptic necrosis in which the indication for arthroplasty was delayed till the terminal stage. As suggested by another recent report from Senegal, efforts should be made to improve the life expectancy of sicklers in Sub-Saharan African countries, by acting on education, social and medical care. Orthopaedic surgery should focus on reducing the failure rate of joint replacement in terminal stages of osteonecrosis and designing core decompression trials in early stages.

[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.

Incidence, case-fatality rate and clinical pattern of firearm injuries in two cities where arm owning is forbidden.

OBJECTIVE: To review firearm injuries in five hospitals of Douala and Yaounde, both towns of Cameroon, a Sub-Saharan African country where ownership of firearm is forbidden. METHODS: This was a retrospective investigation carried out within the period January 1998 to December 2002. Records of the mortuaries, the emergency departments, the intensive care units, the operating rooms and the surgical units were all analysed to identify any injury caused by firearm. Our gold standard was any individual with a clear diagnosis of firearm injury, as determined by a medical doctor. RESULTS: 286 firearm injuries were found; 1.14 cases per 100,000 per year. 66% of cases were due to civilian assaults, 20% to armed forces, 8% to hunting accidents and 6% to accidental handling. There was no case of suicide or of shooting from a relative. The type of weapon was unknown in 31% of cases, it was a hand gun in 36%, a hunting type in 21% and an assault rifle in 12%. The mean age of victims was 33 years and the male:female ratio 5.5:1. The site of injury was unknown in 2%; the head in 6%, the chest in 12%, the abdomen in 31%, the extremities in 46%, the spine in 1% and multiple in 2%. The case fatality rate was 12.58%, and the victims were mainly criminals killed by armed forces assaults; the same ratio of survivors developed late complications. CONCLUSION: The incidence of firearm injuries in the two largest cities of Cameroon is five to fifty times lower than in many other towns, especially in Western countries. This may be due at least partially, to the current legislation on the ownership of firearm which is very restrictive in this country. Some efforts are however needed to reduce illegal access to weapons and to educate hunters on the safe handling of their gun.