Morphological Pattern and Frequency of Intracranial Meningioma in Tanzania

Objective: The objective of the study was to study the histological pattern of intracranial meningiomas; provide a comprehensive data about its frequency in both adults and children and to correlate the site of the tumour with histological diagnosis. Design: A descriptive study. Place and duration of study: The study was carried out at the departments of Histopathology and Morbid Anatomy; Muhimbili National Hospital and Neurosurgery; Muhimbili Orthopaedic Institute in Tanzania; over a period of seven years (1998 to October 2004). Patients and methods :The histopathological data of 54 intracranial meningiomas of adults and children was evaluated on H et E stained sections of paraffin embedded tissue. Results: The ages ranged from 6 to 87 years with mean of 36.6 years. The male to female ratio was 1:1. All histological subtypes of meningiomas were in WHO grade I category and meningotheliomatous type comprised the largest subtype (37). Others were transitional (25.9); fibroblastic (22.2); angiomatous (7.4); psamommatous (5.6) and microcystic (1.9). Out of 54 meningiomas; 43 (79.6) were supratentorial and 11 (20.4) were infratentorial in location. Meningotheliomatous meningioma was the commonest histological subtype in supratentorial region (41.9) while in infratentorial region fibroblastic and transitional subtypes were the commonest (36.4each). Conclusion: All meningioma were in WHO grade I category and meningotheliomatous was the commonest overall and also the most predominant in the supratentorial region while in infratentorial location transitional and fibroblastic subtypes were the commonest with equal frequency. Meningioma gave an equal gender ratio in our study

Morphological Pattern and Frequency of Intacranial Tumours in Adults and Children in Tanzania

Objective: The objective of the present study was to study the histopathological pattern of intracranial tumours and to provide a comprehensive data about their frequency in adults and children less than 16 years and to correlate the site with histological diagnosis.Design: A descriptive studyPlace and duration of study: The study was carried out at the departments of Histopathology and Morbid Anatomy; Muhimbili National Hospital and Neurosurgery; Muhimbili Orthopaedic Institute in Tanzania; over a period of seven years (1998- October 2004).Patients and Methods: The histopathological data of 104 brain tumours of all adults and children less than 16 years histopathologically evaluated was performed on H et E stained sections of paraffin embedded tissue. Special stains were performed whenever indicated.Results: The ages ranged from 2 to 90 years with an overall mean of 34.4 years while that of children below 16 years was 9.5 years and in adults was 41.9 years. The male to female ratio was 1.2:1. Meningiomas comprised the largest category (51.9) and Glial tumours ranked the second (21.4) of primary brain tumours and among all gliomas astrocytomas were the commonest comprising of 16.4 of all intracranial neoplasms. Out of 104 brain tumours; 83(79.8) were supratentorial and 21(20.2) were infratentorial in location while in adults 72(84.7) were in supratentorial region and 13(15.3) were in infratentorial region. In children below 16 years; 11(57.9) and 8(42.1) were in supratentorial and infratentorial in location respectively. The most common tumour overall in both supratentorial and infratentiorial regions were meningiomas (53) and all were in WHO grade I. When age was taken in consideration; meningiomas remained the commonest supratentorial tumours in adult (56.9) while in children below 16 years; cranioparyngioma was the commonest supratentorial neoplasm (45.4). In children less than 16 years medulloblastoma and pilocytic astrocytoma were the commonest neoplasms in the infratentorial region (37.5 of each).Conclusion: Meningioma was the commonest intracranial tumour overall in both supratentorial and infratentorial locations. However medulloblastoma and pilocytic astrocytoma were the most common tumours in the infratentorial region in children below 16 years of age

Radiological investigations and intra-operative evoked potentials for the diagnosis of nerve root avulsion: evaluation of both modalities by intradural root inspection.

Fourteen patients with traumatic brachial plexus injuries underwent intradural inspection of cervical nerve roots to evaluate radiological and intra-operative electrophysiological findings concerning cervical nerve root avulsion from the spinal cord. Four neurosurgeons of our department assessed independently from each other both myelography and CT-myelography concerning intradural nerve root lesions. Each neurosurgeon assessed a total of 26 cervical nerve roots. Two investigators assessed 6/26 and 2 investigators 7/26 nerve roots falsely concerning ventral or/and dorsal root lesions compared with the findings on intradural inspection (23% and 27% false findings). There was a considerable variance concerning the assessibility and findings among the 4 neurosurgeons. Reconstructive surgery was performed after a mean interval of 6.5 months following trauma and 2 weeks following intradural inspection. After exposure of the brachial plexus and the cervical nerve roots in question via a ventral approach, 13 cervical nerve roots were stimulated electrically close to the neuroforamen and cortical evoked potentials (root-SEPs) were recorded from the contralateral postcentral region. All 5 roots with SEPs were intact (no root lesion) and all 8 roots without SEPs showed interrupted (ventral or/and dorsal) rootlets on intradural inspection. Our results demonstrate that false radiological findings concerning root lesions are possible. Intra-operative root-SEPs seem to be a useful aid for evaluation of cervical nerve root lesions. However, more electrophysiological data are necessary to ascertain, if this modality is able to replace intradural inspection in unclear radiological cases in the future.

Laminar and arch fractures with dural tear and nerve root entrapment in patients operated upon for thoracic and lumbar spine injuries.

OBJECTIVE: To determine the neurological outcome in patients with laminar fractures associated with dural tears and nerve root entrapment, operated upon for thoracic and lumbar spine injuries. PATIENT POPULATION: Out of 103 patients operated upon consecutively for thoracic and lumbar spine injuries during the period 1990 to 1994 inclusive, 24 (23.3%) patients had laminar fractures out of whom 3 (2.9%) had an associated dural tear and an other 17 (16.5% or 70.8% of the total patients with laminar fractures) had an associated dural tear and nerve root entrapment. RESULTS: Twelve (70.5%) patients had injury at the thoraculumbar junction, 13 (76.5%) had Magerl's type A3 or above, 10 (58.8%) had a kyphotic angle deformity greater than 5 degrees. Seven (41.1%) had their spinal canal's sagittal diameter reduced by at least 50% and two had dislocations. Nine (52.9%) had initial neurological deficits. Four (50%) out of 8 patients with no initial neurological deficits (Frankel E) worsened to Frankel D. However, one patient among the 3 with initial Frankel A improved to Frankel C while both patients with initial Frankel C usefully improved to final Frankel grades D and E respectively. Two of the four patients with initial Frankel D improved to Frankel E, the other 2 remaining unchanged. All in all five patients neurological status improved, 4 worsened and 8 remained unchanged after neurosurgical treatment. CONCLUSIONS: Vertical laminar fractures with dural tears and nerve root entrapment represent a special group of thoracic and lumbar spine injuries that carry a poor prognosis. However, special operative precautions lead to significant improvement in some of them although a majority remain unchanged or even worsened.

Peripheral nerve schwannomas--an analysis of 16 patients.

16 patients with peripheral nerve neurinomas (benign schwannomas) were operated upon in our hospital between 1990-1995. The largest tumours were found on proximal segments of peripheral nerves (brachial plexus: 15 cm, sciatic nerve: 20 cm). The average duration of symptoms was 1 1/2 years (range: 3 months-15 years). Pain or painful paraesthesias were the main complaints (13/16). Postoperatively, 9 patients were painfree while 4 improved. Similarly, neurological deficits were favourably influenced by the operation: Out of 5 patients with motor deficits 4 had complete, 1 patient had partial recovery. One out of 4 patients with sensory deficits had complete recovery, 2 remained unchanged, while 1 worsened. Two patients developed new motor and 6 patients new sensory deficits, which (in the course of time) did not disappear completely. New deficits developed predominantly in patients with large tumours or longstanding symptoms. Tumour recurrences were not seen during the follow-up period of 23 months. Our findings revealed that in the majority of cases peripheral nerve neurinomas can be excised with good results. Patients should be treated by a neurosurgeon with special expertise in peripheral nerve surgery. The patient should be thoroughly informed pre-operatively about any eventual new neurological deficits following surgery.

DREZ coagulations for deafferentation pain related to spinal and peripheral nerve lesions: indication and results of 79 consecutive procedures.

During a 16 years' period, a total of 79 dorsal root entry zone coagulations were performed in 68 patients for deafferentation pain. Of the 23 patients who underwent surgery for pain due to cervical root avulsion, 18 (82%) had a good (12) or fair (6) pain relief (mean follow-up period 51 months). Twelve (57%) patients with spinal cord injuries noted continuous pain reduction (10 good, 2 fair; mean follow-up 52 months). Continuous marked improvement for longer periods was reported only by 2 out of 10 patients with postherpetic neuralgia and 1 out of 7 patients with painful states due to other brachial plexus lesions and none out of 5 with spinal cord lesions (3) and phantom limb pain (2).

Operative management of achalasia of the oesophagus.

Twenty patients with achalasia of the oesophagus were managed in one thoracic surgical unit over a period of seven years. Eighteen of these were aged 16 to 40 years. There was a female:male ratio of 2:1. Dysphagia to both solids and liquids with diffuse bilateral parotid gland enlargement were the most common clinical features. All the patients had an oesophagomyotomy without an additional anti-reflux procedure. There was no mortality. The trans-thoracic approach for oesophagomyotomy was associated with better results without complications of gastro-oesophageal reflux. This approach is recommended and an additional routine anti-reflux procedure at the same sitting may be unnecessary.

Sister Mary Joseph's Nodule (Umbilical Metastasis): A case report

A 30 year old male patient presented with an umbilical mass that was excised at a peripheral hospital. This recurred five months later. Excision of the recurrent mass and exploratory laparotomy at a consultant hospital revealed multiple intraabdominal metastases and a pelvic tumour. Histological studies revealed features consistent with adenocarcinoma of the rectum

Urinary stone disease in Dar es Salaam.

Forty four adult patients, 34 males and 10 females, with urinary stones were seen over a six-month-period at Muhimbili Medical Centre, Dar es Salaam. Most patients were peasants and semiskilled workers. 8 of the patients were Arabs, which suggests a high predisposition for this race. 12 of the patients had a history of having suffered from bilharzia. There was a high proportion of bladder (and urethral) stones (30%) but upper urinary tract stones were still predominant (70%). Of 20 patients whose stones were available for analysis, 8 were composed of calcium oxalate, 7 of calcium phosphate and 5 of mixed composition. The ratio of stone patients to all hospital admissions of 243 per 100,000 suggests the prevalence of urinary stone disease is comparable to that found in Western countries.