Demographic Profile and Outcome in Surgically Managed Patients with Chronic Subdural Haematoma: A 9-Year Retrospective Cohort Study.

BACKGROUND: Chronic subdural hematoma (CSDH) is achronic inflammatory and angiogenic condition that is potentially fatal and common among the elderly with a probability of gender, racial and ethnic differences. As our population ages due to increase in our life expectancy, a closer look at this disease in our environment is therefore justified. OBJECTIVES: Our objective is to evaluate the epidemiology, relationship of demography, procedure type and mode of anaesthesia on outcome in the patients. METHODS: Retrospective analyses of patients with CSDHs treated by single burrhole, over a 9-year period was performed. Patients' biodata, type of surgery, mode of anaesthesia and discharge outcome were noted. Data were analysed with chisquare, independent t test and multivariate binary regression. Values of p < 0.05 were considered statistical significance. RESULTS: Two hundred and sixty-four patients were managed during the study period. The male-to-female ratio was 2:1 with mean age of 61.4 years. The peak age range was in the seventh decade. Recurrence and mortality rates were 2.7% and 6.8% respectively. Age was significantly associated with mortality. CONCLUSION: The study showed a male preponderance. Age was significantly associated with mortality. Recurrence of CSDH was not related to patients' age, gender or mode of anaesthesia.

CONTEXTE: L'hématome sous-dural chronique (HSC) est une affection chronique inflammatoire et angiogénique potentiellement mortelle et fréquente chez les personnes âgées avec une probabilité de différences entre les sexes, les races et les ethnies. Comme notre population vieillit en raison de l'augmentation de notre espérance de vie, un examen plus approfondi de cette maladie dans notre environnement est donc justifié. OBJECTIFS: Notre objectif est d'évaluer l'épidémiologie, la relation entre la démographie, le type de procédure et le mode d'anesthésie sur le résultat chez les patients. MÉTHODES: Nous avons effectué une analyse rétrospective des patients atteints de CSDH traités par un seul trou de bavure, sur une période de 9 ans. Les données personnelles des patients, le type de chirurgie, le mode d'anesthésie et le résultat de la sortie ont été notés. Les données ont été analysées à l'aide du test de Chisquare, du test t indépendant et de la régression binaire multivariée. Les valeurs de p < 0,05 ont été considérées comme statistiquement significatives. RÉSULTATS: Deux cent soixante-quatre patients ont été pris en charge pendant la période d'étude. Le rapport homme/femme était de 2:1 avec un âge moyen de 61,4 ans. La tranche d'âge maximale se situait dans la septième décennie. Les taux de récidive et de mortalité étaient respectivement de 2,7 % et 6,8 %. L'âge était significativement associé à la mortalité. CONCLUSION: L'étude a montré une prépondérance masculine. L'âge était significativement associé à la mortalité. La récurrence du CSDH n'était pas liée à l'âge, au sexe ou au mode d'anesthésie des patients. Mots-clés: Âge, Hématome sous-dural chronique, Anesthésie locale, Trou de bavure unique.

Evaluating the health risk of metals (Zn, Cr, Cd, Ni, Pb) in staple foods from Lagos and Ogun States, Southwestern Nigeria.

The study evaluated the health risk of metals in commonly consumed staple foods from Lagos and Ogun states, southwestern Nigeria. One hundred and thirty-three food samples were collected and analyzed for Zn, Cr, Cd, Ni, and Pb using atomic absorption spectrophotometric method. Data collected were analyzed for simple descriptive and inferential statistics using SPSS for Windows. The health risk of metals in staple foods was assessed for average daily dose (ADD), hazard quotient (HQ), hazard index (HI), and cancer risk (CR). Results showed the highest concentrations of Zn (18.99 ± 13.62 mg kg-1) and Ni (0.21 ± 0.10 mg kg-1) in beans, while the highest amount of Cr (2.04 ± 1.44 mg kg-1) was obtained in rice. Cd concentrations in staple foodstuffs ranged from < 0.01 to 0.30 mg kg-1, while Pb was below the detection limit. The average levels of Zn in beans and maize were higher than the recommended dietary allowance (9.5 mg kg-1) of the Institute of Medicine. The mean concentrations of Cr and Cd (except for rice) in staple food samples were also higher than the permissible standards. The health risk data revealed HQ value greater than 1.0 for Cr in the food samples, indicating non-carcinogenic adverse health effects. The HI value greater than 1.0 in staple foods established cumulative adverse effects of metals. The carcinogenic evaluation of Cr (in all the food samples) and Ni (in beans) showed CR values greater than the acceptable limit of 1.0 × 10-4, thereby demonstrating possible development of cancer through consumption of the staple foodstuffs.

Congenital Cirsoid aneurysm communicating with the sagittal sinus and supplied by extra and intracranial arteries.

We describe the unique case of a 6-year old boy who presented with recalcitrant generalized tonic-clonic seizures and clinicoradiological features of congenital Cirsoid aneurysm. The lesion was supplied by occipital arteries and a large right parietal parasagittal intracranial feeding artery in a Yokouchi type C pattern. The venous drainage was communicating with the posterior part of the superior sagittal sinus. Six months after successful ligation of the feeding arteries and complete surgical excision of the lesion, the patient remains seizure free.

Neurotrauma burden in a tropical urban conurbation level I trauma centre.

BACKGROUND: Neurotrauma is a preventable public health problem whose quantum is said to be increasing in Third-World countries. This evaluation was performed to collate data which is needed to guide in designing, implementing, and evaluating public health prevention programmes with respect to neurotrauma. METHODS: A single institution prospective study was carried out. Data was collected at the surgical emergency (SE) room over a year period (1st October 2012-30th September 2013). These included patients' demographics, cause of injury, region of the body involved, Glasgow coma scale score, and outcome. The patients were further divided into patients with traumatic brain (TBI) and spine injury (TSI). Analysis of the variables was by simple proportion, percentages, Chi-square and analysis of variance was used to determine the differences between group means. A probability (p) of less than 0.05 was considered statistically significant. RESULTS: A total of 2149 neurotrauma cases (38.8%) out of a total of 5541 surgical trauma cases were seen within the study period at our SE unit. Of the neurotrauma cases, 1621 were males, giving a male:female ratio of 3.1:1. The mean age was 31 years (median 30 years). The most common age group was 20-29 (29.6%) and 30-39 years (29.6%). Assault was the cause of neurotrauma in 903 patients (42%), closely followed by road traffic injury in 744 patients (34.6%). Brain and spine injury separately occurred in 93.2% and 5.3% of cases, respectively. Five hundred patients (23.3%) were resuscitated and referred to other centres due to lack of bed space. Forty (1.9%) patients were dead on arrival, while twenty-six (1.2%) died while on treatment at the emergency room. CONCLUSION: Neurotrauma is one of the most common form of trauma at our surgical emergency. Assault and road traffic injury (RTI) were the most common cause of TBI and TSI respectively, with RTI being the most common cause of moderate and severe TBI. The incidence and aetiology of TBI varies according to age and gender.

Visual function in infants with congenital hydrocephalus with and without myelomeningocoele.

OBJECTIVES: Congenital hydrocephalus without or with associated myelomeningocoele has impaired visual function as a potential complication. The present study was embarked on to determine the frequency of optic nerve deficits and refractive errors in this group of children and document any relationship to neuroradiological measurements. MATERIALS AND METHODS: All infants with congenital hydrocephalus associated with myelomeningocoele (MHC) and congenital hydrocephalus without myelomeningocoele (HC) were prospectively studied. The children underwent clinical neuro-ophthalmological evaluation and neuroimaging. Radiological confirmation and severity of hydrocephalus was by Evans ratio (frontal and occipital) and third ventricular diameter. RESULTS: There were 50 children (27 boys and 23 girls, median and mean age of 6 and 5.4 months, respectively) included in the study. Eighteen patients (36%) had no or poor visual tracking and fixation, while nine (18%) patients had optic atrophy. Optic atrophy was significantly associated with the HC group (p = 0.007), while the MHC group was significantly associated with a lower Evans ratio (occipital ratio, p = 0.000; frontal ratio, p = 0.000). Forty-nine patients had anisometropia. The refractive errors were more commonly hypermetropia (46 patients). This was not significantly associated with HC or MHC (0.309). CONCLUSION: Optic atrophy rarity in MHC is probably due to early presentation of the patients and lower Evans ratio (occipital and frontal). Evans ratio is a good predictive index for optic atrophy in infantile congenital hydrocephalus. Refractive errors frequency is not dependent on an association of myelomeningocoele with or without hydrocephalus.

Posterior spinal decompression, stabilization and arthrodesis in Nigerian adults: Profile and outcome.

BACKGROUND: The availability of intraoperative fluoroscopy and improved access to varieties of spinal titanium implants has revived posterior spinal stabilization techniques with their distinct advantages. Our aim is to describe the profile of various spine pathologies requiring subaxial posterior spinal decompression, stabilization (using titanium implants), and arthrodesis, and to determine the rate of postoperative complications and factors affecting outcome. MATERIALS AND METHODS: This is a prospective single institution study of consecutive adult patients seen during the study period. Data collected included the patients' demographics, radiological findings, indication for surgery, surgical procedure, operation time, intraoperative blood loss, and postoperative complications. RESULTS: There were 26 patients (15 males and 11 females). Their ages ranged between 24 and 78 years (median = 42 years). The most common indications for surgery were spinal trauma and degenerative spine disease (24 patients). The region that was most commonly stabilized was the lumbar- 12 cases (46.2%). No patients experienced neural or vascular injury as a result of screw position; likewise no patient had screw loosening. There was a case each of superficial surgical site infection and transient cerebrospinal fluid leak but no case of implant failure was encountered. The outcome was significantly associated with the etiology (0.030) of the indication for surgery and preoperative power grade (0.000). CONCLUSION: Spinal trauma and degenerative spine disease are the two most common indications for posterior spinal decompression, stabilization and fusion in our center. It is associated with acceptable postoperative complication rate when done under fluoroscopic guidance. Outcome is related more to the preoperative neurological deficit and etiology of the indication for surgical stabilization.

Surgical congenital central nervous system anomalies in a tropical teaching hospital.

BACKGROUND: Surgical congenital malformations of the central nervous system (CNS) are structural defects with potential for morbidity and mortality more so if intervention is delayed. AIM: To determine the frequency and pattern of surgical CNS anomalies in our region. METHODS: We carried out a hospital-based prospective observational study of all consecutive children who presented to our unit over a 2-year period. Brain computerised tomography and/or magnetic resonance imaging was performed on all patients suspected of having cranial CNS abnormalities. RESULTS: There were 94 children with surgical congenital anomalies of the CNS during the study period, with a male to female ratio of 1:1.1. There was no parental consanguinity in all the cases neither were there any history of preconception use of folic acid in all the mothers of the patients. Prenatal ultrasound was done after the first trimester in 91 cases (97%), but anomaly was noted in only 23 cases (25.3%). Eighty-six percent of the patients presented after the first month of life. Though there was a general delay in presentation, patients with neural tube defect tended to present much earlier compared to others (p = 0.005). Likewise, patients with spinal anomalies tend to be seen much earlier. CONCLUSIONS: Late presentation of CNS anomalies is still the norm in our region. The result makes a case for an aggressive approach to periconceptional folic acid supplementation for our women and policy to encourage fortification of a staple food with folic acid. A nationwide effort to fully clarify the epidemiology is needed so as to indicate where the community and governmental resources, including educational efforts should be directed.

Surgical anatomy of the vertebrobasilar territory and posterior circle of Willis.

BACKGROUND: In the present era of microscopic and neuroendoscopic procedures, the surgical anatomy of the skull base vessels has gained increased significance. The pattern of the vertebrobasilar arterial complex and the posterior circle of Willis (COW) in Nigerians has not been previously reported despite various variants of these complexes existing in different populations. OBJECTIVE: To review and document the size, distribution and anomalies of the vertebrobasilar territory and posterior COW pattern in a Nigerian set of brains. METHODS: The target population for this study was a group of Nigerian adults 18 years and above. Specimens from patients with an ante-mortem or post-mortem evidence of meningitis or atherosclerosis were excluded. The size, distribution and anomalies of the vertebrobasilar artery, its branches, and the posterior COW were defined in 50 brains. RESULTS: The male: female ratio was 1.9:1 and a mean age of 44 years. Statistical analysis showed significant differences between the sizes of posterior inferior cerebellar arteries and anterior inferior cerebellar arteries (Student's t=-30.189; p-value= 0.000). Fifty-six percent of the brains had no anomalies. Thirty anomalies were noted in posterior COW compared with six in the vertebrobasilar territory. There were no aneurysms in all the specimens studied. CONCLUSION: Anomalies in the region of the posterior COW are commoner than the vertebrobasilar territory and the region of the posterior communicating artery is the most common site of anomalies in the posterior COW territory. These variations should be taken into account during skull base and carotid surgeries, and cerebral angiography.

Hydrocephalus and subdural effusion with extracranial extension complicating meningitis.

Post-meningitic subdural effusion does not extend extracranially. To our knowledge, the association of hydrocephalus and extracranial extension of a subdural effusion has not been previously reported. We present a case of an 8-year-old boy who presented with progressive head enlargement and worsening pulsatile peri-orbital swelling of 1 year duration. Cranial computerized tomographic scan confirmed communicating hydrocephalus and bilateral subdural effusion worse on the right side. The patient had a ventriculo-peritoneal shunt, with resolution of the subdural effusion and his hydrocephalus.

Neurocritical Care Audit in a Tertiary Institution

Background:The `open' intensive care unit (ICU) predominates in most low and middle economy societies. This is associated with paucity of personnel and cost challenges involved for its maintenance and smooth unning despite the great public demand for this service. Data on neurocritical care in scare in Nigeria and the subregion as a whole. Our objective is to audit our neurocritical care facility; human resources; patient admission and outcome. Patients and Method: We conducted a retrospective audit of all patients admitted to our `open' ICU following a neurological indication. This study was carried out over a one year period (January 2008-December 2008). In addition to patients' boidata; we recorded date of admission; indication for admission; treatment (operative/non-operative); ventilatory support if any; and outcome (Alive or dead). Results: One hundred and twenty-nine patients were admitted during the study period; 85 (65.9) of which was due primarily to a Neurosurgical indication. The overall mortality was 25.9while mortality of ventilated patients was 64.5Mortality rate was significantly by ventilation.Conclusion: Neurological patients account for most of our ICU admission. Hospitals with ICUs should ensure that they have a proper high dependency unit. We also ecommend that appropriate equipments and staff training in the area of neurocritical care be incorporated into existing `open' ICUs in our environment. The use of protocol for ventilated patients and managing common ICU cases and common procedures should enhance treatment outcomes

Surgical Anatomy of the Vertebrobasilar Territory and Posterior Circle of Willis

BACKGROUND: In the present era of microscopic and neuroendoscopic procedures; the surgical anatomy of the skull base vessels has gained increased significance. The pattern of the vertebrobasilar arterial complex and the posterior circle of Willis (COW) in Nigerians has not been previously reported despite various variants of these complexes existing in different populations. OBJECTIVE: To review and document the size; distribution and anomalies of the vertebrobasilar territory and posterior COW pattern in a Nigerian set of brains. Methods: The target population for this study was a group of Nigerian adults 18 years and above. Specimens from patients with an ante-mortem or post-mortem evidence of meningitis or atherosclerosis were excluded. The size; distribution and anomalies of the vertebrobasilar artery; its branches; and the posterior COW were defined in 50 brains. RESULTS: The male: female ratio was 1.9:1 and a mean age of 44 years. Statistical analysis showed significant differences between the sizes of posterior inferior cerebellar arteries and anterior inferior cerebellar arteries (Student's t = -30.189; p-value = 0.000). Fifty-six percent of the brains had no anomalies. Thirty anomalies were noted in posterior COW compared with six in the vertebrobasilar territory. There were no aneurysms in all the specimens studied. CONCLUSION: Anomalies in the region of the posterior COW are commoner than the vertebrobasilar territory and the region of the posterior communicating artery is the most common site of anomalies in the posterior COW territory. These variations should be taken into account during skull base and carotid surgeries; and cerebral angiography

Dimensions, septation, and pattern of pneumatization of the sphenoidal sinus.

The endoscopic endonasal transsphenoidal approach (EEA) to treat sellar, parasellar, and suprasellar tumours continues to gain increased significance. Due to the close proximity of the sphenoid sinus to the carotid artery and the optic canal, it is very important for surgeons to know the anatomical features and variations of the sphenoid sinus as relevant to EEA. A prospective study of the sphenoid sinus morphology was carried out on the cranial tomographic (CT) scan images of 60 Nigerian adult patients. The CTs were reviewed regarding the different anatomical variations of the sphenoid sinus: dimensions, septation, and pattern of pneumatisation. There were 37 males and 23 females. The patients' ages ranged from 18 years to 85 years, with a mean of 47.2 years. There was a main single intersphenoid septum in most patients (95%). The insertion of the septum was usually to the right posteriorly (38%) and in the midline anterior (65%). Although there is usually a main septum, the septa present were multiple in 29 of the sinuses studied. There was no gender difference with respect to the attachment of the main sphenoid sinus septum. The sphenoid anterior, posterior, and transverse dimensions were not significantly dependent on age, but they were longer in males than in females. Sellar pneumatization was present in the majority of the patients (83%), with 4 patients having postsellar pneumatization (6.7%) and 3 patients having presellar pneumatization (5%). There were no cases with conchal pneumatization or lateral pneumatization of the greater wing of the sphenoid. The present study provides anatomical information about the sphenoid sinus dimensions morphology that is essential for avoiding complications in performing an endoscopic sphenoidotomy.

Delay in presentation and diagnosis of adult primary intracranial neoplasms in a tropical teaching hospital: a pilot study.

Sixty-three adult patients with intracranial neoplasms were studied prospectively over a 2 year period. The various factors related to pre-presentation symptoms interval (PSI) and pre-diagnostic interval (PI) were noted. The mean age at presentation for all patients was 46.8 years (range 18-72 years, median 46 years). Meningiomas (30%), Pituitary tumours (18%), High-grade gliomas (14%) and craniopharyngiomas (8%) were the most common brain tumours. The median PSI of all patients was 2 year (range 2 months-5 years) with a PI of 4 weeks (range 0-8 months). The PSI and PI were longer for women with a statistical significance between the PSI and gender (p=0.016). The tumour grade was significantly correlated with PSI (p=0.000) and PI (p=0.043). Late presentation and diagnosis were due to cultural and religious beliefs compounded by self medication and financial constraint. There is the need for widespread mass enlightenment, improvement in accessibility and affordability of neuroimaging facilities coupled with subsidization of treatment.

Outcome of endoscopic third ventriculostomy and Chhabra shunt system in noncommunicating non-tumor childhood hydrocephalus.

BACKGROUND: Endoscopic third ventriculostomy (ETV) the main alternative to ventriculoperitoneal shunt (VPS) is just beginning to have a foothold in West Africa. It provides a great opportunity for a hydrocephalic child to be shunt free. The purpose of this paper is to compare outcome following ETV and VPS (using the cheap Chhabra shunt) in children with noncommunicating non-tumoral hydrocephalus in an environment where late presentation is the norm. MATERIALS AND METHODS: Sixty-three pediatric patients (< 6 years) with hydrocephalus who underwent a VPS or ETV at our hospital were included in this study. The study period was of 30 months (January 2006 till June 2008). Clinically successful outcome was defined as no event occurring during or after surgery that resulted in an alternate surgical procedure, or significant post-operative complication that includes death. All complications related to the procedures were also analyzed. RESULTS: The outcome of surgical intervention was not significantly related to the gender, age of the patient at surgery, or type of surgery. The post-operative complication rate was similar in both groups. CONCLUSIONS: The clinical outcome of ETV is comparable to that of VPS, with the added benefit of no shunt-related problems; and being a short procedure, patient anesthesia and operation time, hospital stay, and cost are significantly reduced. We consider ETV to be the procedure of choice for the treatment of noncommunicating nontumoral hydrocephalus in the pediatric population.

Congenital Hydrocephalus in Mono and Dizygotic Twins

Background: Information regarding the occurrence of hydrocephalus (HC) in twins is important in establishing the significance of environmental factors as well as a genetic basis in congenital HC aetiology. This was the basis for this study. Methods: A single institution retrospective study was conducted between August 1; 2006 and July 31; 2008. Only those cases of hydrocephalus (based on clinical and radiological testscranial Computeried tomographic or Magnetic resonance imaging scan) that required placement of a ventricular shunt or endoscopic third ventriculostomy were included in the study. Data regarding the patient's demographics; clinical history; examination and the maternal demographics were retrieved and analysed. DNA analysis was done to confirm the fraternity of the twins when applicable. Results: Fifty-eight patients with congenital hydrocephalus presented to the unit over the study period. We identified three sets of twins in the study. Only one set were identical (both male) and both had hydrocephalus. In the remaining two sets only one out of each pair had hydrocephalus (one male and one female). Two of the patients (1male; 1female) were twins with discordant HC. All the children had normal thumbs. DNA analysis confirmed identical twins in both the like sex twins. The mothers were not known diabetics; hypertensive or sickle cell patients neither did they smoke or take alcohol. There was no family history of hydrocephalus in all patients. Conclusion: Concordance for HC is likely if the twins are like sex and identical. Congenital hydrocephalus seems to be a multifactorial disorder; triggered by environmental factors in genetically predisposed individuals

Anomalies, aneurysm and histology of the middle cerebral artery in Nigerian Africans

The histology of the middle cerebral artery (MCA) in Nigerian Africans has not been previously studied. One hundred MCAs obtained at autopsy from fifty adult Nigerians were studied. The vessels were processed and stained with Ehrlich's haematoxylin and eosin, elastic Van Gieson and Masson's trichrome stains. Early branches were given off before the perforators in two middle cerebral arteries, and there was one accessory MCA, making an incidence of anomalies of 3 percent. No aneurysm was observed in any of the cases. The internal elastic laminas were well developed but the external elastic laminas of the vessels were poorly developed. Close to the bifurcations the tunica media tapered gradually and at the bifurcations, the tunica media was completely deficient being replaced by the tunica adventitia (Forbus raphé). The tunica adventitia was thicker at the bifurcations (0.21mm) compared to other sites of the vessel. The average thickness of the MCA tunica media at its origin was 0.12mm while that of the tunica adventitia was O.lOmm. These results are similar to what has been described in the literature for Caucasians. It buttresses the assertion that anatomical anomalies of the MCA are rare. The seemingly low frequency of MCA aneurysms in Nigerian Africans is not due to its anomalies or histology.

La histología de la arteria cerebral media (ACM) de los africanos de Nigeria no ha sido previamente estudiada. Fueron examinadas 100 ACM, obtenidas en autopsias de 50 individuos nigerianos adultos. Las arterias fueron procesadas y teñidas con hematoxilina y eosina de Ehrlich, Van Gieson para fibras elásticas y tricrómico de Masson. Ramas proximales se originan antes de la división en dos arterias cerebrales medias, y había una ACM accesoria, constituyendo una incidencia de anomalías del 3 por ciento. No se observó aneurisma en ninguno de los casos. La lámina elástica interna estaba bien desarrollada, pero la lámina elástica externa de los vasos estaba pobremente desarrollada. Cerca de la bifurcación la túnica media es gradualmente cónica, la túnica media es totalmente deficiente siendo sustituida por la túnica adventicia (Forbus raphé). La túnica adventicia es más gruesa en las bifurcaciones (0.21mm) en comparación con otros lugares del buque. El grosor medio de la túnica media de ACM en su origen fue 0.12mm mientras que el de la túnica adventicia de O.lOmm. Estos resultados son similares a los que han sido descritos en la literatura para Caucásicos. Es importante la afirmación que las anomalías anatómicas de la ACM son raras. La aparentemente baja frecuencia de los aneurismas de ACM en nigerianos africanos no es debido a sus anomalías o a la histología.

Outcome of myelomeningocoele repair in sub-Saharan Africa: the Nigerian experience.

OBJECTIVE: Early repair of myelomeningocoele (MM) is associated with decreased morbidity and mortality. In sub-Saharan Africa, the peculiar harsh economic and social realities make late presentation, malnutrition and sepsis at presentation prevalent. As these factors may affect surgical repair, the aim of this study was to review the outcome of repair of MM in this peculiar patient population. MATERIALS AND METHODS: A prospective study of patients with MM who presented at the Lagos State University Teaching Hospital, Lagos, Nigeria over a 12 month period was studied. Follow up ranged from 8 weeks to 1 year. RESULTS: Five patients died while awaiting surgery. Thirty-six patients, 24 males and 12 female infants with MM were operated on during the study period. Majority of the patients were operated on or after the seventh day of life. The median age at surgery was 11th day of life (range second day-2 years). The mean surface area of the myelomeningocoele was 26.4 cm(2) (range 12.6-62.9 cm(2)). The post-operative morbidity and mortality was five and one, respectively. CONCLUSIONS: Intracranial sepsis is the main cause of death in MM patients who are not operated on time. The patients we are seeing are probably those that survived to present at the hospital; by that time primary closure is usual without the need for complex plastic procedures. Delay in presentation even with associated malnutrition and local sepsis seems not to significantly affect the outcome of MM repair.

Lessons from History: Human Anatomy, from the Origin to the Renaissance / Lecciones de Historia: Anatomía Humana, desde el Origen hasta el Renacimiento

The well-known fact that history writers always seem wiser than the subjects on whom they write is the most logical inherent proof that history is rich in lessons. The history of Anatomy is not an exception. It is full of imperative lessons in the Art and Science of the discipline of Anatomy, which following generations ought to learn. We present a defined brief survey with this in mind.

El hecho bien conocido que los historiadores siempre parecen ser más sensatos que los sujetos sobre quienes escriben, es la más lógica prueba que la historia es rica en lecciones. La historia de la Anatomía no es la excepción. Ella está llena de lecciones imperativas en el arte y ciencia, de la cual generaciones venideras deberían aprender. Presentamos un breve reconocimiento sobre lecciones de la Historia de la Anatomía.

Non-operative management of benign intracranial hypertension presenting with complete visual loss and deafness.

Benign intracranial hypertension (BIH) may lead to blindness and rarely deafness. We describe the case of a rapidly deteriorating 14-year-old African girl who presented with headaches associated with complete visual and hearing loss due to BIH. This was managed non-operatively with lumbar cerebrospinal fluid tap, weight reduction, nicotinic acid and acetazolamide. Response to treatment was quite dramatic with resolution of severe headaches and regaining of light perception 8 days after commencing treatment. By 3 months hearing recovered to normal and there was resolution of vision. This to the best of our knowledge is the first reported case of complete visual and hearing loss occurring in a patient with BIH, which was managed successfully non-operatively. When indicated, non-operative management is an effective treatment option even in malignant BIH.

Intrascrotal anomalies related to testicular torsion in nigerians: an anatomical study

Objective: The abnormalities that predispose to torsion are often bilateral. They include horizontally lying testis; bell-clapper deformity (BCD); long mesorchium; well-developed spiral cremasteric muscle and ectopic testis. The pattern and incidence of intrascrotal anomalies that predispose to testicular anomalies in Nigerians have not been studied. Our objective was to define and document this. Material and Methods: The scrotal sacs of fifty cadaver scrotums and inguinal canals from patients aged between 35 and 57 years (mean age: 42 years) were examined. The parameters studied were the location (scrotal or canalicular); alignment (horizontal; vertical); mesorchium (height and width); cremasteric muscle development (well or poorly developed) and parietal tunica vaginalis investment of the testis (normal; intermediate or BCD). Results: Forty-nine testes had descended to the scrotal position; all were anchored by the ligamentum testis. The canalicular position was noted to be present in one cadaver. Forty-eight testes lay vertically. 16of the testes had BCD; while intermediate tunica investment was noted in 12. The most common type of epididymal and testicular relationship was Type I (84). The mesorchium was normal in all specimens examined. Conclusion: The most common anomaly in our study was that of tunica investment; and this is usually bilateral. The need for bilateral orchiopexy in cases of testicular torsion is further strengthened since the anatomic anomalies are usually bilateral