Marios C. Papadopoulos

A novel and accurate diagnostic test for human African trypanosomiasis

INTRODUCTION Human African trypanosomiasis (sleeping sickness) affects up to half a million people every year in sub-Saharan Africa. Because current diagnostic tests for the disease have low accuracy, we sought to develop a novel test that can diagnose human African trypanosomiasis with high sensitivity and specificity. METHODS We applied serum samples from 85 patients with African trypanosomiasis and 146 control patients who had other parasitic and non-parasitic infections to a weak cation exchange chip, and analysed with surface-enhanced laser desorption-ionisation time-of-flight mass spectrometry. Mass spectra were then assessed with three powerful data-mining tools: a tree classifier, a neural network, and a genetic algorithm. FINDINGS Spectra (2-100 kDa) were grouped into training (n=122) and testing (n=109) sets. The training set enabled data-mining software to identify distinct serum proteomic signatures characteristic of human African trypanosomiasis among 206 protein clusters. Sensitivity and specificity, determined with the testing set, were 100% and 98.6%, respectively, when the majority opinion of the three algorithms was considered. This novel approach is much more accurate than any other diagnostic test. INTERPRETATION Our report of the accurate diagnosis of an infection by use of proteomic signature analysis could form the basis for diagnostic tests for the disease, monitoring of response to treatment, and for improving the accuracy of patient recruitment in large-scale epidemiological studies.

Godfrey Hounsfield and the dawn of computed tomography.

OBJECTIVE:To provide a historical account of the events surrounding the development of the computed tomography scanner. METHODS:Information was obtained by interviewing people who worked with Sir Godfrey Hounsfield and Dr. James Ambrose at Atkinson Morleys Hospital in the 1970s, and from published books, articles, and several web sites, including the Nobel web site. RESULTS:The computed tomography scanner was successfully developed because of the collaboration between an imaginative engineer, Godfrey Hounsfield, who created the machine, and a brilliant neuroradiologist, James Ambrose, who demonstrated its wide clinical significance. CONCLUSION:The computed tomography scanner represents one of the most important contributions to neurosurgical practice in the past 100 years, and its development is a remarkable story of scientific endeavor.

Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study.

Objectives Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their countrys specific demographics and healthcare system. Considering Englands specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources. Design Retrospective cohort study using Hospital Episode Statistics data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyse trends. Outcome measures Trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay. Results Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100 000, respectively, (p<0.001). The increase was most marked in the oldest age groups with a 1.9 and 2.33-fold increase in admissions for patients aged 60–74 and ≥75 years, respectively, and a 2.8-fold increase in procedures for those aged ≥60 years. Trends in hospital admissions were characterised by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay (p<0.001). Trends in procedures were characterised by a narrowing gender gap, increasing mean patient age (p=0.014) and decreasing mean hospital stay (p<0.001). Linear regression models estimate that each hospital admission translates to 0.27 procedures, per 100 000 (95% CI 0.25 to 0.30, r 0.99, p<0.001; r, Pearsons correlation coefficient). Hospital admissions are increasing at 3.5 times the rate of surgical procedures (regression gradient 7.63 vs 2.18 per 100 000/year). Conclusions LBP represents a significant and increasing workload for hospitals in England. These trends demonstrate an increasing demand for specialists involved in the surgical and non-surgical management of this disease, and highlight the need for services capable of dealing with the increased comorbidity burden associated with an ageing patient group.

Penetrating Head Injury in Planned and Repetitive Deliberate Self-Harm

44-year-old man presented to his local emergency department wearing a baseball cap and complaining of headaches that had progressively worsened over the preceding 11 weeks. After we provided generous analgesia and performed simple investigations that failed to identify a diagnosis, the patient removed his cap to reveal an assortment of metallic objects embedded in his scalp. Plain radiographs showed 11 nails penetrating into his brain. A detailed history revealed a diagnosis of paranoid schizophrenia, and the patient confirmed that he had hammered a nail into his head each week for the past 11 weeks to rid him of evil. The nails were removed with the patient under general anesthesia, and he made an uncomplicated recovery with no neurological deficits.

An unusual cause of sciatica

ISSN: 0268-8697 (Print) 1360-046X (Online) Journal homepage: http://www.tandfonline.com/loi/ibjn20 An unusual cause of sciatica Isabel Tulloch & Marios C. Papadopoulos To cite this article: Isabel Tulloch & Marios C. Papadopoulos (2016): An unusual cause of sciatica, British Journal of Neurosurgery, DOI: 10.1080/02688697.2016.1226261 To link to this article: http://dx.doi.org/10.1080/02688697.2016.1226261

Cervical cord presyrinx

A 25-year-old woman presented with two months history of high-pressure headaches and unsteady gait. On examination, she had truncal ataxia, but no long tract signs. Craniospinal MRI showed hydrocephalus, an arachnoid cyst in the posterior fossa and cervical cord oedema without cavitation (Fig. 1). Several treatment options were considered including surgical excision of the cyst, shunting and endoscopic fenestration. We elected to excise the cyst because it was easily accessible and we felt that excision would definitively tackle the problem with low morbidity, without relying on the patency of shunts or endoscopic fenestrations. She therefore underwent posterior fossa craniectomy and excision of the cyst. An MRI done a week after surgery, showed complete resolution of the cord oedema (Fig. 1).

Contralateral lumbosacral plexopathy following lumbar microdiscectomy

Abstract We describe the unique case of a 51-year-old lady who developed a contralateral lumbosacral plexopathy two days after a lumbar microdiscectomy. This is the first report to date of this complication occurring following this procedure. We review the literature regarding lumbosacral plexopathy and discuss the evidence base behind investigating and managing this condition and the potential pathophysiological mechanisms which underlie its development. We draw comparisons with the more widely recognised post-operative brachial neuritis, characterised by delayed onset brachial plexopathy developing after cervical decompression, and propose an immune-mediated inflammatory mechanism linking the two conditions.