Medical admissions of oncology patients to the University Hospital of the West Indies

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7 percent of total admission to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62 percent were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7 percent of admissions, the commonest being renal and/or hepatic impairment: anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35 percent of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).(AU)

Emergency bypass without bypass

We present 2 cases of failed coronary angioplasty, with hemodynamic compromise, where emergengy coronary artery bypass. The hypodynamic nature of the stunned myocardium in this circumstance allow this technique to be applied with relative ease to accessible vessels. As a consequence, reduced morbidity and hospital stay can be anticipated.{AU}

Spinal epidural abscess: diagnosis and management

Three cases of spinal epidural abscess managed at the University Hospital of the West Indies are presented. This disorder, a neurosugical emergency, runs a variable course, and, if improperly managed, may lead to paraplegia and death. The aetiology, diagnosis and management of this disease are discussed (AU)

A hospital based study of patient and physician response to acute myocardial ischaemia - abstract

A prospective study was undertaken to investigate whether current patient and physician response to acute myocardial ischaemia was suffiently expedient to allow for thrombolysis within the first 6 hours of evolving acute myocardial infarction. During the 1-month study period, 70 patients with chest pain syndrome presented to the Accident and Emergency Department, General Hospital, Port-of-Spain (A&E, POSGH). Data were available on 67 patients, of whom 38 (57 percent) were found to have definite myocardial ischaemia by E.C.G. criteria. The modal time of arrival was 1-3 hours after the onset of chest pain. Sixty-four per cent of all patients arrived within 6 hours of the onset of chest pain. The corresponding figure for the subgroup with confirmed ischaemia was 68 percent. The mean time for evaluation and disposition of patients with confirmed ischaemia in the A&E, POSGH was 47.5 minutes (range 20-112 minutes). Furthermore, the longer time taken for triage of patients who did not have an eventual diagnosis of myocardial ischaemia (57.6 vs 47.5 min) is consistent with the urgency of physician management and the likelihood of ischaemia. The result of this study suggest that the majority of patients presenting to the A&E, POSGH for the treatment of acute myocardial ischaemic s

Morbidity pattern of emergencies at the Bustamante Hospital for Children (January-December, 1986)

A one-year retrospective study of paediatric emergencies seen at the Bustamante Hospital for Children for the period January 16 to December 31, 1986 is presented. Thirty-four per cent (3,918) of a total of 11,495 patients seen in the Casualty Department for 100 randomly selected days were assessed as emergencies. The most frequently seen emergencies were gastroenteritis (42.55 percent of total emergencies) followed by bronchial asthma (23.0 percent) and shortness of breath (16.51 percent). The rigid classification of emergencies by disease category needs to be reappraised (AU)

Fracture of the penis

An experience with six cases of fractured penis is described. A `rolling sign' accurately identifies clot at the fracture site and facilitates a direct and rapid approach to the torn corpus cavernosum. Early operation hastens recovery and limits deformity.(AU)

Some medical emergencies associated with swimming and diving

The risks, diagnosis and emergency management of drowning, ear injuries, burst lung and decompression sickness which may occur in swimming and diving are discussed. Emphasis is put on the importance of early diagnosis and of reaching recompression facilities as early as possible when appropriate (AU)

Emergency tracheostomy

A series of 78 cases of emergency tracheostomy performed at the Kingston Public Hospital from 1944 to date is considered. The overall mortality rate was 50.2 per cent. Of 11 cases done by the ear, nose and throat unit within recent months, two died of causes unrelated to the operation. Possible causes of mortality and morbidity, and various details of operative and postoperative care are discussed. A routine for post operative care as followed in the Department of Otolaryngology of the Kingston Public Hospital is decsribed. It is recommended that all tracheostomies be performed by one specific unit and that the postoperative care be the responsibility of that unit. (AU)