Thursday, January 15, 2009

Back Pain for 6 Months

Sorry for the silence.  The power went out yesterday, and I'm a little GI sick today so I'm not moving as quickly as I could.  The following images are from the MRI scanner that I took a picture of a few posts back.  This patient has had back pain for 6 months, take a look at the images and see what you think.

Basically there is a giant mess of infection in this patient's spine from a long-term infection with tuberculosis.  Tuberculosis of the spine is also known as Pott's disease.  The sharp crook in her back is called a gibbus deformity.  This is something that you would NEVER see in the states, but is common in other parts of the world where Tb is endemic.  Other great cases from neuro conference include - a cervical spine astrocytoma, a rare sarcoma of the sphenoid wing, and a few meningiomas.

On this Tuesday we went to the orthopedic conference where the residents (a.k.a. registrars) discuss the patients that they have cared for over the weekend with the attending.  One patient had a horrible fracture of the right hip (acetabular fracture) from a tractor that fell on his pelvis. The registrar reported that the patient had been waiting for surgery for 3 weeks in the ward, and proceeded to describe a difficult course in the operating room because "the patient had purchased the wrong plate and screws" and it wasn't identified until the patient had already been sedated and an incision made.  They somehow made things work to repair his fracture, which looked decent on the post-op X-ray.  My jaw just about hit the floor!  I'm positive that the cause of the delay in treatment was because the patient was trying to raise the necessary funds for the hardware, which is just stunning.  The amount of pathology here is staggering, particularly in MTRH (Moi Teaching and Referral Hospital - the public hospital here).

Finally, the CT repair folks from Nairobi finally arrived (close to a week after they said they were coming) and are working on the CT machine.  Hopefully they will be able to return it to good working condition.  Unfortunately, the repair guy said that the CT scanner itself will not DICOM send.  The raw data needs to be processed on a workstation (read $$$) and then sent to an archive.  In non-geek this means that my dream for a basically free digital image archive for Kenya won't work with this CT scanner.  We'll have to wait until the next one comes along :-(

Another introduction - Laura and Tim.  Laura is a resident from Minnesota studying med-peds (I think?)  She's here on her third trip, and definitely is experienced in the ways of East Africa - she lived in Uganda for a year!  Tim has done half of IU Med School and is working on finishing his MPH at Yale.  He does research and works with the street kids who live here in Eldoret, I hear that they all love him and his big crazy hair.
Headed out to Lake Baringo Island Camp for the weekend, so more pictures next week, I promise!

1 comment:

Isaac said...

WOW, those images are epic! Really fascinating. We'll be thinking about you tonight man. I'll give the lady a squeeze for ya :)