Kokou Adambounou

A Low-Cost Tele-Imaging Platform for Developing Countries

Purpose: To design a “low-cost” tele-imaging method allowing real-time tele-ultrasound expertise, delayed tele-ultrasound diagnosis, and tele-radiology between remote peripherals hospitals and clinics (patient centers) and university hospital centers (expert center). Materials and methods: A system of communication via internet (IP camera and remote access software) enabling transfer of ultrasound videos and images between two centers allows a real-time tele-radiology expertise in the presence of a junior sonographer or radiologist at the patient center. In the absence of a sonographer or radiologist at the patient center, a 3D reconstruction program allows a delayed tele-ultrasound diagnosis with images acquired by a lay operator (e.g., midwife, nurse, technician). The system was tested both with high and low bandwidth. The system can further accommodate non-ultrasound tele-radiology (conventional radiography, mammography, and computer tomography for example). The system was tested on 50 patients between CHR Tsevie in Togo (40 km from Lomé-Togo and 4500 km from Tours-France) and CHU Campus at Lomé and CHU Trousseau in Tours. Results: A real-time tele-expertise was successfully performed with a delay of approximately 1.5 s with an internet bandwidth of around 1 Mbps (IP Camera) and 512 kbps (remote access software). A delayed tele-ultrasound diagnosis was also performed with satisfactory results. The transmission of radiological images from the patient center to the expert center was of adequate quality. Delayed tele-ultrasound and tele-radiology was possible even in the presence of a low-bandwidth internet connection. Conclusion: This tele-imaging method, requiring nothing by readily available and inexpensive technology and equipment, offers a major opportunity for telemedicine in developing countries.

Neurovascular Conflicts of Cerebellopontine Angle: A Review of the Literature

The pathology of the cistern of the cerebellopontine angle is primarily the disease of the nervous and vascular structures that it contains and of the meninges that line it. It appears by the Trigeminal Neuralgia (TN), Hemifacial spasm (HFS), and Glossopharyngeal Neuralgia (GN). We have reviewed the anatomy, pathogenesis, diagnostics and therapy of neurovascular conflicts of cerebellopontine angle. The clinical manifestations of the conflict vary according to the affected nerve. The diagnosis is made on the basis of symptoms but need to be confirmed by imaging. Now-a-days, high-fields Magnetic Resonance Imagings (MRIs) are the standard gold diagnostic method but stay impervious in areas or countries that are less medically equipped. The treatment of neurovascular conflicts of cerebellopontine angle is conservative or interventional. The interventional acts constitute the only curative treatments.