Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume.

Motor Neurone Disease Edited by F. Clifford Rose. (Pp. 147; illustrated; £7.00.) Pitman Medical Press: Tunbridge Wells. 1977. It is now some five years since the last symposium on motor neurone disease at the Johns Hopkins Hospital. The present volume is a report on the proceedings of the latest symposium on this condition. The editor has produced a balanced presentation from clinical and epidemiological, pathological and electrophysiological disciplines. The 13 chapters are contained in 140 pages including the references so that each is a fairly short and, in all cases, readable review of a particular approach to the problem. The reader already familiar with the problems of motor neurone disease may find little new information in this book but it does summarise usefully the present state of knowledge of the condition. Some pointers for further research are outlined, the application of studies of axonal transport to motor neurone disease, and the question of slow viruses in the aetiology of the condition. I think, however, that the reader will be left with the impression that, despite the accumulation of much information on the disease, there is as yet little evidence that we are much nearer to an understanding of its aetiology. This is a clear summary of the present state of knowledge of motor neurone disease and it should certainly be read by everyone who has an interest in that condition.

https://jnnp.bmj.com/content/jnnp/41/2/191.3.full.pdf

Pathology of Tumours of the Nervous System.

Traumatic brain injury: progress and challenges in prevention, clinical care, and research

Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions. A search was conducted using Medline, African Index Medicus, the Directory of Open Access Journals, and the LILACS/BIREME/SCIELO database. Included studies were in English, published after 1992, and reported safety, cost, or outcomes of laparoscopy in LMICs. Studies pertaining to arthroscopy, ENT, flexible endoscopy, hysteroscopy, cystoscopy, computer-assisted surgery, pediatrics, transplantation, and bariatrics were excluded. Qualitative synthesis was performed by extracting results that fell into three categories: advantages of, challenges to, and adaptations made to implement laparoscopy in LMICs. PRISMA guidelines for systematic reviews were followed. A total of 1101 abstracts were reviewed, and 58 articles were included describing laparoscopy in 25 LMICs. Laparoscopy is particularly advantageous in LMICs, where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage, rising rates of trauma, and single income households. Lack of trained personnel and equipment were frequently cited challenges. Adaptive strategies included mechanical insufflation with room air, syringe suction, homemade endoloops, hand-assisted techniques, extracorporeal knot tying, innovative use of cheaper instruments, and reuse of disposable instruments. Inexpensive laboratory-based trainers and telemedicine are effective for training. LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than English or in journals not indexed by the included databases. Surgeons, policymakers, and manufacturers should focus on plans for sustainability, training and retention of providers, and regulation of efforts to develop laparoscopy in LMICs.

Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies.

An Ethiopian Training Program in Neurosurgery with Norwegian Support

Objective: Information about hydatid cyst disease in Ethiopia is scarce. This study was aimed at reviewing the clinical presentations, modes of surgical management and post-operative course of patients with hepatic hydatidosis in Tikur Anbessa hospital, Methods: This was a retrospective study of 137 patients seen with hepatic hydatidosis at Tikur Anbessa Hospital, Department of Surgery, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia. Results: The male: female ratio was 1.2:1. Patients’ age ranged from 13 to 67 years with a mean of 33.5 years. The majority (65%) of the patients came from the rural Ethiopia and 40% of the patients had been in frequent contact with domestic animals such as dogs. Abdominal pain and abdominal mass were the commonest symptoms. A palpable mass or hepatomegaly was found in 89.8% of cases, Ultrasonography and computed tomography were the main diagnostic procedures. The cysts were located in the right lobe of the liver in 76 patients (55.5%) and in the left lobe in 38(27.7 %); the other 23 patients (16.8%) had bilobar involvement. Most patients (78.1%) had a solitary cyst. Twenty-three patients had hydatid cystic lesions in other organs in addition to hepatic hydatidosis. The surgical approach was abdominal in 122(89.1%) patients, one- stage thoracoabdominal in 8(5.8%), and laparotomy and thoracotomy at interval in 7(5.1%) patients. Operative management consisted of conservative procedure in 126(92%) patients, namely evacuation in 93(67.9%), cystotomy in 21(15.3%), enucleation of intact cyst in 12(8.8%) patients. Radical procedure was done in 11(8%) patients, wedge resection in 10(5.8) patients, and lobectomy in only 1(0.7%) patient Twenty-seven (19.7%) patients developed Postoperative complication. Conclusion: Complete excision of hydatid cyst(s) and procedures that conserve liver tissue are appropriate for most patients with hepatic hydatid cysts.

/pdf/hydatid-disease-of-the-liver-a-12-year-experience-of-2zyev6n2d2.pdf

Hydatid disease of the liver: A 12 year experience of surgical management

BACKGROUND Disc degeneration is common, the pattern and prevalence of various signs of disc degeneration is unclear Neither hospital nor population-based data or study is available on lumbar disc diseases in Ethiopia The sequelae of disk degeneration are among the leading causes of functional incapacity in both sexes and are a common source of chronic disability in the working years Lumbar disc disease refers to a collection of degenerative disorders that can lead to low back pain as people age OBJECTIVE Review the pattern, clinical manifestation, diagnostic method and management decision of patients with degenerative lumbar disc disease at the neurosurgical referral clinic of Tikur Anbessa Hospital during the fiscal year 2009 PATIENTS AND METHODS This is a hospital based cross sectional study of patterns of patients with lumbar disc diseases seen at the neurosurgical referral clinic, Tikur Anbessa Specialized Teaching Hospital (TASTH), Department of Surgery, Addis Ababa, Ethiopia in the period between January and December 2009 (12 months) Data taken while clerking patients and patents' medical record at referral clinic were main source of information Standardized and structured questionnaire prepared for this purpose were used to analyze the sociodemographic, clinical manifestation, diagnostic modalities such as lumbar myelography, CT and MRI, patterns of disc disease in lumbar spine at NSRC with reference to age, severity and level distribution were reviewed Difference in proportions were examined using Chi-square test RESULTS The study reviews 364 patients with lumbar disc diseases at the neurosurgical referral clinic, TASH over the one-year period (2009), their age ranged from 20 to 82 years (median, 440) Pain, numbness and neurologic claudication were the three most common presenting symptoms, occurring in 337(925%), 232 (6376%) and 111 (305%) respectively Lumbar MRI was the statistically significant investigation modality of choice (p < 00001) Two hundred thirty-five (701%) patients had disc prolaps (P < 00001), 185% had disc bulge Lumbar degenerative disc disease was most frequently seen at L4-L5 level in 309 (545%) patients (P < 00001) both L4-L5 and L5-S1 accounted for 791% of the disc displacements On MRI, disc displacements, were central in 612%, lateral in 93% and posterolateral in 158%

Review of lumbar disc diseases at Tikur Anbessa Hospital.

OBJECTIVE The aim of this study was to evaluate the pattern and surgical management of hydatid disease. METHODS A hospital based retrospective cross sectional analysis was conducted in Tikur Anbessa Hospital, department of surgery, Addis Ababa, Ethiopia. Patients' medical records and operation theater registers of 234 patients operated upon for hydatid disease between September 1995 and August 2005 were analyzed RESULTS One hundred and twenty three patients were male and 111 female. Their age ranged from 13-69 years, with median and peak age of incidence of 30 and 21-30 years respectively. Hundred forty five (62.0%) patients were from rural population. Significant number of patients (40.6%) came from Oromiya regional state (p < 0.004). The most common presenting symptoms were pain in 206/234 (88.0%) patients with hydatidosis, mass or organomegally in 106/141(75.2%) patients with intraabdominal hydatid diseases, cough in 91.2% and expectoration in 83.3% of cases of thoracic hydatidosis. Liver and lung (79.6%) are the most commonly affected organs. More than one organ involvement was seen in 13.7% of cases. Ultrasonography and chest roentgenography were the main modalities of investigation of abdominal and thoracic hydatidosis respectively. Surgical techniques employed for removal of cysts was evacuation in 181 (67.3%). capitonnage in 167 (62.1%) and pericystectomy in 47 (17.5%) organs. In 191 (81.6%) patients the postoperative course was uneventful while 15.8% developed postoperative complications. There were six deaths. The follow up period ranged from 1 month to 3 years (mean 5.6 months). CONCLUSION Hydatidosis is not uncommon in rural communities of Ethiopia particularly in Oromiya. Complete excision of the disease processes with maximum preservation of tissue is safe and ideal for most patients with hydatidosis.

Surgical management of 234 patients with hydatid disease: the Tikur Anbessa Hospital experience.

Objective This review aims to evaluate retrospectively 72 patients diagnosed to have thoracic hydatid disease and treated surgically in Tikur Anbessa Hospital between December 1993 and November 2003. Design Retrospective Analysis hospital records. Settings Tikur Anbessa Hospital, Department of Surgery, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia. Patients and methods Medical records and Operation theater registers of seventy-two Patients operated on for Thoracic hydatidosis were evaluated retrospectively. Chest Roentgenogram was the main diagnostic tool used Main surgical techniques employed were evacuation in 44 (52.4%) cysts, cystotomy in 30 (35.7%) cysts, and enucleation in 10 (12%) cysts. Additional palliative procedures (such as pericystectomy and Capitonnage) and radical procedures (such as resection of the lung) were also employed. Results forty of the patients were male and thirty-two female with a mean age of 31.4 years. The most Common presenting symptoms were cough in 60 (83.3%) patients, expectoration in 47 (65.3%) patients and chest pain in 38 (52.8%) patients. Chest radiography revealed a round opacity or shadow in 58 (80.6%) patients. All patients were treated surgically. The mean hospital stay was 38.3 days. Major postoperative Complications occurred in 12 (16.9%) patients; pneumonia, pleural effusion and prolonged air leak were the complications in order of their frequency. There was one postoperative death and one recurrence at 6-months follow-up period. Conclusion Surgical excision of pulmonary hydatidosis with maximum preservation of lung parenchyma is possible in the majority of patients and should remain the mainstay of surgical treatment.

Experience of surgical therapy in 72 patients with thoracic hydatidosis over a 10-year period.

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