Penetrating wounds to the torso: the University Hospital of the West Indies experience

OBJECTIVE: This study was done to determine the aetiology of penetrating torso injuries in patients presenting at the University Hospital of the West Indies (UHWI) as well as to document the organs frequently injured and to assess the outcome of these cases. DESIGN AND METHODS: Data were derived from the UHWI trauma registry. All patients presenting to the UHWI with penetrating torso injuries between January 1, 1998 and June 30, 1999 were studied. Biographic data, cause of injury, organs injured and procedures used in treatment were recorded. TRISS methodology was used to identify unexpected deaths. RESULTS: 1899 (42 percent) of the 4,496 admissions to the surgical services of the UHWI were due to trauma. Two hundred and twenty-nine (229) of these had torso injuries and 159 (8 percent) were due to penetrating injuries. Assaults accounted for 98 percent of cases. The male to female ratio was 7.4:1 and the mean age was 28 +or- 10 (SD) years. There were 92 (59 percent) stab wounds and 63 (41 percent) firearm injuries. Mean hospital stay was 8 +or- 15 (SD) days. Mortality rate was 10 percent. Small bowel (17), colon (15) and liver (15) were the abdominal organs most frequently injured. Pneumothorax or haemothorax was detected in 107 patients. All except 20 patients had a major surgical procedure done. There were seven non-therapeutic thoracotomies and 17 non-therapeutic laparotomies. Greater than 50 percent deaths were assessed as preventable. CONCLUSIONS: The wider use of imaging procedures in treatment protocols should reduce the number of non-therapeutic procedures. The preventable death rate may be decreased through training in ATLS protocols and improved equipment maintenance.(Au)

Spontaneous pneumothorax in acute paraquat toxicity

Spontaneous pneumothorax as a presenting feature of acuteparaquat toxicity is as yet unreported. A review of the literature has shown that there has been one reported case of spontaneous pneumothorax occurring after paraquat (Nakaoka et al, 1987). The two cases of paraquat ingestion presented in this report are associated with spontaneous pneumothorax in the acute phase. A proposed mechanism for the development of the pneumothorax is discussed (AU)

Penetrating wounds of the thorax

A review of penetrating wounds of the chest seen at the University Hospital of the West Indies during the period January, 1974 to December, 1976, is presented. Haemothorax can be successfully treated by tube thoracostomy and underwater seal drainage. Emergency thoracotomy was necessary for bleeding in excess of 1,000 cc after tube thoracostomy, continued bleeding following tube thorascomy with associated signs of shock, a large entry wound, cardiac tamponade and associated inta-abdominal injury. All patients with cardiac tamponade who reached the hospital alive survived following thoracotomy and cardiorrhaphy (AU)

The treatment and fate of two hundred persons seen in the tuberculosis clinic, Port of Spain, between 1947 and 1950 (abstract only)

The treatment and fate of 205 cases of tuberculosis seen for the first time in the Port of Spain clinic between June 1947 and October 1950 are described. These were cases for whom treatment was believed to be of value. During the same period, four or five times as many patients were seen, whose condition was so advanced that no form of treatment was advised. These cases were treated initially by artificial pneumothorax and pneumoperitoneum and only 18 percent were given drugs at any time. There is evidence that (1) artificial pneumothorax and pneumoperitoneum are of value in considerable numbers of cases as a preparation for some form of other treatment.(AU)