Surgical management of lumbar disc prolapse in Addis Ababa.

Of 40 cases of lumbar disc prolapse, 30 involved the L4/5 disc. There was a preponderance of males, M:F ratio of 5.7:1. All 40 cases were unresponsive to medical treatment and underwent bilateral laminectomies and discectomies at the respective levels. The operative findings were; two free prolapses, 34 major disc bulges compressing the lumbar theca and nerve roots, and four lateral disc protrusions. The post operative course was uneventful except one case with wound dehiscence. The remainder were discharged upon improvement.

Meningioma resembling an epidermoid tumor.

A case of retro-orbital meningioma who presented to the Department of Surgery, Neuro-surgery Unit of Tikur Anbessa Hospital in June 1993 with a progressive right eye proptosis is described. Exploration through a right frontal craniotomy showed a well circumscribed and encapsulated thickened bony tumor that had a cavity containing a cheesy-yellowish oily material. The lesion was successfully shelled-out. The preoperative diagnosis was meningioma. However, based on its intraoperative macroscopic appearance, mode of presentation, and location of the lesion an impression of an epidermoid tumor (cholesteatoma) was made. The result of histologic examination turned out to be meningioma (psammomatous type). Literature review on both conditions, the pathologic characteristics and clinical features are discussed briefly.

Cushing's syndrome: a ten year experience at Tikur Anbassa Hospital.

A retrospective analysis of Cushing's syndrome from the retrieved records of 24 out of a total of 27 referred cases over a period of 10 years (January 1985-January 1995) showed confirmation in 16 cases. Fourteen (88%) were females, 9 (56%) were in their third decade. Duration of symptoms before admission was one year or less in eleven (69%) patients. Among symptoms weakness, fatigue and weight gain and among signs moon face, truncal obesity and buffalo hump were found in all patients. Amenorrhea occurred in all the women of childbearing age. Basal urinary 17-hydroxycorticoid (17-OHCS) values were elevated in 9/12 patients and low dose dexamethasone suppression test favoured Cushing's syndrome in 8/9 patients. Definitive treatment consisted of bilateral adrenalectomy in 7 and transfrontal pituitary adenomectomy in 3. Two patients declined surgery; 4 patients were lost to follow up before definitive treatment. Two patients who had bilateral adrenalectomy and two who had transfrontal adenomectomy died subsequently while three remained in good health on corticosteroid replacement therapy. Three of the 7 patients who had bilateral adrenalectomy developed Nelson's syndrome. It is concluded that Cushing's disease is the most frequent cause of Cushing's syndrome in our series. The patients presented with the well-known clinical manifestations of hypercortisolism. However, our laboratory facilities require considerable improvement to serve as a reliable adjunct to clinical evaluation. Since Cushing's syndrome, whatever the cause, is eventually fatal if left untreated, surgical intervention is mandatory after confirmation of the cause with appropriate laboratory tests.