London Academic Publishing Ltd.: Arts & Humanities Journals
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Brain abnormalities associated with myelomeningocele at Kinshasa University Teaching Hospital in the Democratic Republic of the Congo
No full textBackground: Myelomeningocele (MMC) is the most prevalent neural tube defect, with significant implications for both health and development. The presence of associated brain abnormalities is crucial in determining the prognosis for affected children, making early detection and accurate diagnosis essential.Objective: This study aimed to evaluate the prevalence of brain abnormalities in children with MMC, assess the accessibility of cranial imaging, and identify the most common associated brain malformations.Methods: A retrospective study was conducted, focusing on children diagnosed with myelomeningocele and admitted to Kinshasa University Teaching Hospital from January 2014 to December 2021. The study reviewed clinical data, including the use of cranial tomography, and identified the frequency and types of brain abnormalities.Results: Thirty-five children with MMC underwent cranial tomography. The average age of these patients was 43 days, and the male-to-female ratio was 1.5. Notably, 34.3% of mothers did not undergo any obstetric ultrasound, and only 5.7% of mothers who had an ultrasound received an antenatal diagnosis of MMC. Brain abnormalities were observed in 91.4% of the cases. Hydrocephalus was the most prevalent anomaly (93.7%), with aqueductal stenosis identified as the primary cause (60%). The most common surgical treatment was the simultaneous treatment of MMC with ventriculoperitoneal shunt (44.4%). Postoperative recovery was uneventful in 59.2% of patients.Conclusion: The study highlights the high prevalence of brain abnormalities in children with myelomeningocele, particularly hydrocephalus caused by aqueductal stenosis at Kinshasa University Teaching Hospital. The findings underscore the critical need for improved access to prenatal care and diagnostic imaging to detect congenital malformations early, especially in resource-limited settings like Kinshasa
Thirty-Three Moments of the Soviet Position on the German Question: A Microhistory
No full textThis article presents the microhistory of the Soviet position on the German question from 1985 to 1990, drawing on Russian-language archival materials, mainly Gorbachev’s correspondence published by the Gorbachev Foundation. In addition to offering this microhistory, it aims to illuminate the long-debated “not one inch eastward” assurance by analysing its context. This research demonstrates that, during 1989-1990, Western oral pledges to the Soviet leadership regarding NATO’s non-enlargement sometimes specifically referred to the territory of the (former)1 GDR, at other times to the Eastern Bloc beyond the (former) GDR, and in some instances resembled a general promise of NATO’s future non-enlargement to the east. Furthermore, the article highlights that during the negotiations on Germany, the Soviets had concerns about pro-NATO aspirations in the Eastern Bloc (beyond the GDR) and the risks of future NATO enlargement eastward, beyond the (former) GDR. Ultimately, the article proposes a theoretical framework to explain why the Soviets accepted a status quo that risked NATO’s eastward expansion, despite their awareness of the associated risks and the absence of any legal guarantees against enlargement
Psychiatric and neurobehavioral effects of posterior fossa surgery: A literature review
No full textThe posterior fossa, housing the brainstem and cerebellum, has traditionally been viewed as exclusively responsible for motor functions. However, recent literature has highlighted the profound cognitive and psychiatric implications of lesions and surgery in this area. This literature review analyses case studies, clinical series, and systematic reviews regarding post-surgical neuropsychiatric sequelae in the posterior fossa. Relevant studies on cerebellar mutism, cerebellar cognitive affective syndrome, and emotional lability were included. Posterior fossa pathology is associated with a wide spectrum of disorders. Posterior Fossa Syndrome (PFS) is a common pediatric complication, characterised by mutism and irritability. In adults, although rarer, subtle personality changes, executive dysfunction, and severe emotional lability caused by brainstem compression can occur. Pathophysiological mechanisms involve the disruption of cerebello-cerebral circuits (diaschisis). Recognising postoperative psychiatric complications is essential. Neuropsychological assessment should be routine in posterior fossa surgery to optimise patient recovery and quality of life. This review may serve as a structured framework for future prospective and statistical studies that systematically evaluate psychiatric and cognitive outcomes after posterior fossa surgery
Outcome of endovascular treatment of giant aneurysm : A retrospective study
No full textIntroduction: Very large and giant aneurysms are among the most challenging cerebrovascular pathologies in neurosurgery. The risk of aneurysmal rupture compounds with an increase in the size of the aneurysm thus warranting appropriate intervention.
Objective: To analyze the outcome of endovascular treatment of giant aneurysm.
Materials and Methods: A retrospective study was conducted at the Department of Neurosurgery. 35 cases were selected from the database with radiological diagnoses of giant aneurysm referred to our departments from 2016 to 2023.
Results: The patients mainly belonged to >60 years age group (37.14%) and had a mean age of 49 years, with a slight female preponderance (57.14%). Aneurysms were mainly located in patients who had left internal carotid artery (ICA) supraclinoid aneurysms (14.29%) and right middle carotid artery (MCA) bifurcation aneurysms (14.29%). The patients predominantly underwent simple coiling (45.7%) and stent-assisted coiling (42.8%). Of 35 patients, 2 (5.7%) died. The recurrence was higher in posterior circulation aneurysms with, 75% in basilar top aneurysms (3 out of 4 cases), 50% in posterior communicating artery aneurysms (one out of 2 cases), 37.9% in remaining cases (11 out of 29 patients).
Conclusion: Giant aneurysm is associated with reasonably high morbidity and mortality. The aneurysms are found most often in the anterior circulation, while the recurrence is mainly observed in the posterior circulation have more chances of recurrence. However, favourable outcome was frequently observed (94.3%)
Gemistocytic astrocytoma mimicking hypertensive haemorrhage: A rare case of tumour disguised as intracerebral haemorrhage
No full textGemistocytic astrocytoma is a rare variant of diffuse astrocytoma, characterized by a high proportion of gemistocytic cells, which exhibit aggressive behaviour and an increased risk of malignant transformation. Its clinical and radiological presentation can be misleading, especially when it mimics other intracerebral pathologies, such as hypertensive intracerebral haemorrhage (ICH). Differentiating between a primary hemorrhagic event and a hemorrhagic tumour remains a significant diagnostic challenge.
We report the case of a 56-year-old male with no prior medical history who presented with sudden-onset right-sided hemiparesis and severe speech disturbances. Initial neuroimaging revealed a deep intraparenchymal hematoma in the left internal capsule, and lenticular nucleus, strongly suggestive of a hypertensive hemorrhagic stroke. Despite intensive medical management, the patient’s condition deteriorated, prompting further imaging studies, which raised suspicion of an underlying neoplastic process. Subsequent MRI findings indicated features atypical for a purely hemorrhagic lesion, necessitating neurosurgical intervention for definitive diagnosis.
The patient underwent a left fronto-temporo-parietal craniotomy, during which a tumour-like mass was encountered and completely resected. Histopathological analysis confirmed the diagnosis of gemistocytic astrocytoma. Postoperatively, the patient showed gradual neurological improvement, though residual deficits persisted.
This case highlights the complexity of differentiating a gemistocytic astrocytoma from a spontaneous hypertensive haemorrhage, particularly in patients without a prior oncological history. While intracerebral haemorrhage is commonly associated with chronic hypertension, intratumoral haemorrhage remains an important differential diagnosis, especially when imaging findings suggest a mass effect, perilesional oedema, or progressive neurological deterioration despite optimal medical therapy. MRI characteristics, such as hyperintense T2-weighted and FLAIR signals, can provide critical clues, but histopathological confirmation remains the gold standard.
Gemistocytic astrocytomas, though rare, should be considered in cases of unexplained intracerebral haemorrhage, particularly when imaging findings or clinical progression are atypical. This case underscores the importance of a multidisciplinary approach involving neurology, neuroradiology, and neurosurgery to ensure timely diagnosis and appropriate management. A high index of suspicion is crucial to prevent delays in the recognition and treatment of hemorrhagic brain tumours, which can significantly impact patient outcomes
A new Thrasymachus: Genealogy and Essentialism in Plato’s Republic
No full textThis article seeks to reread Thrasymachus, or more precisely, fragments of Thrasymachus’ position, in Book I of the Republic. To do so, I begin by articulating the sophist’s function as a philosophical-literary character. As Plato takes on the dual role of philosopher and writer, the interpreter of the Republic approaches Thrasymachus as both the mouth piece for a (possibly confused) set of claims and, as I seek to show, a plot device. Because the interpreter doesn’t only ask “what argument wins out?” but, “what lesson does Plato wish us to learn by argument X winning out?”, Thrasymachus is approached internally to the philosophical-literary throughline of the Republic. In this article, I suggest that this practice clips the wings of a portion of Thrasymachus’ position. This occurs because the philosophical-literary approach of the interpreter has as its condition that Thrasymachus thinks within the essentialist underpinnings of the Republic. Yet, this article argues that elements of Thrasymachus’ position don’t lend themselves to essentialism, and indeed call it into question. In the closing portion of this article, Foucault is turned to as a source of a critical methodology (in particular the genealogy) that can strengthen those anti-essentialist Thrasymachean fragments. I conclude that the interpretive tendency to approach Thrasymachus internally to the Platonic throughline of the Republic has withheld access from fragments which, precisely because of their incompatibility with said throughline, are the most rewarding to consider
A case report of a large gluteal schwannoma with pelvic extension
No full textBenign schwannomas are slow-growing, painless tumours originating from Schwann cells, which form the sheaths of peripheral nerves. These tumours are relatively rare, with an incidence of 1-3 cases per 100,000 individuals annually. While they are most commonly found in the head, neck, and spine, schwannomas can also occur in the extremities, particularly in the upper limbs. Tumours in the pelvis and gluteal region are less frequent but are clinically significant due to their potential to compress adjacent structures.
We present a case of a 74-year-old male patient who underwent surgery for a large schwannoma in the gluteal region, extending into the pelvis at the level of the piriformis muscle and sciatic foramen. Initially misdiagnosed and treated as sciatica, this case highlights the importance of considering schwannomas in the differential diagnosis of patients presenting with neurological symptoms in unusual locations. Sciatic symptoms that do not respond to conservative treatment should be further investigated, and a thorough palpation of tender and painful points should always be performed to aid in the potential diagnosis of a local soft tissue tumour
A rare case of cerebral astroblastoma
No full textCerebral Astroblastomas are rare central nervous system tumours constituting 0.45-2.8% of neuroglial tumours Recent 2021 WHO classification of Brain tumours has described Astroblastoma as “other neuroepithelial tumours” with MN1 rearrangement. Because of its rare entity and indistinctive radiological and pathological features diagnosis and further management continue to remain a challenge. Ependymoma and angiocentric glioma are the most important differential diagnoses of Astroblastoma and at times pre-operative differentiation is challenging. Here we discuss the case of a 22-year-old female with features of headache and vomiting. Histopathological examination revealed Cerebral Astroblastoma MN1 altered. Post-operative imaging suggested gross total resection of the tumour and the patient was subjected to radiotherapy of 54Gy in the tumour bed. 1-year followup of the patient showed no recurrenc
Carpal Tunnel syndrome surgery: A 10-year retrospective analysis of 442 cases
No full textCarpal Tunnel Syndrome (CTS) is the most common peripheral nerve entrapment neuropathy, caused by compression of the median nerve at the wrist. It leads to hand pain, numbness, tingling, and weakness, often affecting the thumb, index, middle, and ring fingers. CTS frequently requires surgical treatment (carpal tunnel release) when symptoms are moderate to severe or unresponsive to conservative measures.
We analyzed a cohort of 442 CTS patients treated surgically over the last 10 years at the County Clinical Emergency Hospital of Sibiu (312 women, 130 men; 308 urban residents, 134 rural; average age 59 years) and compared the outcomes and characteristics with findings from the literature. This report examines risk factors and comorbidities associated with CTS, surgical outcome metrics (recurrence, failure, complications), bilateral involvement patterns, laterality, urban-rural differences, and occupational contributions, supported by recent studies
Stigma/ta: Eyes Slant like Chinks of Christ, or Chin-Kee of American Born Chinese
No full textGenuine pushbacks from Asian North American—off-white, yellow-ish—minority against white mainstream stereotypes are few and far between, given that the bulk of off-white (self-)representations blossom in English after a lifetime of nurture by, and internalization of, white culture. Thus, in their mother tongue of English, projected from the white patriarchal gaze, off-white visual culture reprises Western Orientalist polarization of the “Chink,” pardon my Americanism. On the one hand, the racial slur “Chink” stigmatizes the they-all-look-alike Asian Other as having eyes slanting upward and/or in long narrow slits, from Robert Hans van Gulik’s self-designed book cover to off-white Gene Luen Yang’s graphic books and Domee Shi’s animations. On the other, the West projects its own longing onto the exotic Other, whose visual, auditory, and sensorial differences “open sesame” to otherworldly, fantastical escapades. The offensive stigma of slant-eyed Asians hence morphs into, not to mince words, the crucified Christ’s stigmata, windows to the soul of transcendent resurrection. The West—white as well as off-white—manages to eat the body of the Other and to have it, too, as proof of the West’s spirituality. This project examines cases of Oriental stigma of slanting eyes transformed into stigmata of white and off-white spiritual triumphalism. I hereby talk back against the linguistic and cultural hegemony that schizophrenically splits the racial or immigrant other, skewing/skewering Oriental eyes, from Van Gulik to Yang, Shi, and the like. Let us turn our gaze to those strange, even monstrous, eyes in the mirror