Penetrating Injury to the Great Vessels: Case reviews and management approaches for West Indian Surgeons

Penetrating injury to the great vessels in the thorax is an increasingly common and alarming clinical scenario in the West Indies, and in Jamaica in particular. The management of these often life-threatening injuries involves careful surgical planning and prompt operation, with close adherence to the principles of adequate pre-operative stabilization and investigations, and intra-operative exposure and repair. While this may be more easily accomplished in tertiary care centres, the geographical realities of the West Indies require that every surgeon be familiar with these techniques. A report of the management of some recent cases is followed by a review of the subject and recommended treatment strategies are outlined.(AU)

On the role of tortuous coronary arteries in billowing mitral leaflet syndrome: a hypothesis

Sixty three male patients with billowing mitral leaflet syndrome (BML) and forty one age and sex match controls were studied with emphasis on the cineangiographic features of coronary arteries. In the BML group, the coronary arteries were considered normal in five and abnormal in fifty eight. In fifty eight with abnormal coronary arteries, twelve showed atherosclerotic occlusive lesion, fifteen showed combined occlusive lesions and nonocclusive abnormalities and thirty one showed nonocclusive abnormalities alone. The non-atherosclerotic abnormalities consisted of redundancy of the coronary arteries manifested by bizarre changes in configruation and motion. These abnormalities were present in only five patients in the control group. On the basis of our observations and corroborative evidence in the literature, a hypothesis is presented; the salient features of which are that: (1) the spectrum of BML may be considerably more complex than hitherto suspected, (2) a combination of BML and tortuous coronary arteries may form a distinct subset of this spectrum and (3) the increased tortuousity may result in impaired coronary perfusion causing myocardial ischemia thus offering a possible explanation for some of the symptoms- such as chest pain, arrhythmias and even sudden death seen in this syndrome. (AU)

Quantitative aspects of electrocardiograms of adults in a Jamaican rural population

The values of selected measurements from scalar electrocardiograms of a representative Jamaican population are reported. The tracings were obtained from 1067 adults aged 35 to 64 years, just under 90 percent of 1200 men and women selected randomly from a defined community of a hilly inland rural area. The participants were mostly small farmers, and their womenfolk, and they were of African origin. Measurements included intervals, axes, and amplitudes and three indices of left heart involvement-Morris's index of left atrial disease, Estes' score for left ventricular hypertrophy, and the Sokolow-Lyon criteria. Their distributions are compared with data from similar epidemiological studies and provide values for an ethnic group for which there are few population-based reports. The striking feature of these tracings was the high proportion with evidence of left ventricular hypertrophy, particularly those of men. The relation between certain electrocardiographic characteristics and age, body built, arterial pressure, and heart rate was investigated by multiple regression analysis, and this showed that little of the variation of most electrocardiographic measurements were explained by these variables. (AU)

Intralobar pulmonary sequestration in association with bilateral systemic arterialization of the lungs

Over 250 cases of intralobar pulmonary sequestration have now been reported (Ranniger and Valvassori, 1964). The diagnosis which may be suscepted on the clinical, plain radiograph and bronchographic findings, depends on the angiographic or operative demonstration of an aberrant systemic arterial supply to the affected segment. The preoperative angiographic visualization of this pulmonary systemic arterialization arising from the thoracic or abdominal aorta either as a single large vessel (McDowell, Robb, and Indyk, 1955) or as multiple small arteries (Turk and Lindskog, 1961) to a large extent eliminates the operative hazards (Harris and Lewis, 1940). This paper reports an unusual case of pulmonary intralobar sequestration in association with bilateral aberrant systemic arteries. The angiographic and operative findings suggest that this may be a case of bilateral pulmonary sequestration (Summary)

Environmental temperature and response to premedicant drugs

A total of 105 subjects have been studied, 70 in the hot climate of Jamaica and 35 in the temperate climate of England. Following the same premedication a very significant alteration from resting levels in the arterial pH and PaCO3 occurred in the subjects in Jamaica, but there was no change in the Jamaican and English groups in England. This sensitivity was shown to be related to a lowereing of the metabolic rate in the hot climate. There was no relationship to race, liver disease, or immediate ambient room temperature (AU)

Subclavian artery aneurysm and idiopathic cystic medionecrosis

The clinical, radiological, and pathological findings in case of localized aneurysm of the left subclavian artery due to cystic medionecrosis are presented. The patient was a 22-year-old Negress with no stigmata of Marfan's syndrome. The aneurysm was treated successfully by resection and insertion of a Dacron graft. The pathogenesis of the aneurysm is briefly discussed. A search of the published material has failed to reveal any such case previously reported (AU)

A report on investigations designed to measure an index of the hardness of arteries in vivo and in situ

It was considered that if means could be devised which measured the compressibility and distensibility of the arteries in vivo it might be possible to measure those changes which are generally designated as hardening. It is proposed in this communication to deal with the first of these two factors, that is , compressibility. The key to the measurement of the compressibility of the arteries was a technique which provides a measurement of the resistance to flow through the larger arterial vessels. This arterial flow measurement was used to provide an index of the degree of collapse of the brachial artery when various external pressures were applied. This technique will be described and a preliminary report on the use of this record on those subjects which were clinically designated as having hardened arteries (AU)