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)

Coronary angiography and myocardial perfusion scintigraphy: a correlative analysis - abstract

The assessment of myocardial perfusion has for many years been performed with thallous chloride (T1-201). This imaging agent suffers, however, from a number of well-recognized limitations, which has prompted a global search for better radiopharmaceuticals. Within the last two years, Technetium labelled myocardial perfusion imaging agents, namely, Sestamibi (Du Pont Pharma) and Tetrofosmin (Amersham) became available, and prompted us to evaluate the efficacy with respect to coronary angiography (CA) recently introduced at our institution. The data for both imaging agents were analyzed in fifty consecutive patients (ages 30 to 70 years), referred over the past eighteen months for myocardial perfusion scintigraphy (MPS). Twenty-five patients had combined MPS and CA studies. Comparative analysis for individual coronary artery territories yielded a sensitivity of 97 percent, specificity of 80 percent and an overall accuracy of 80 percent for MPS. Angiographic review of initially ascribed false positive MPS in eight patients revealed pathophysiological abnormalities other than coronary artery stenosis which accounted for the observed perfusion deficits. These included differential blood flow in two patients and myocardial bridging in one. The remaining false positives were attributed to diaphragmatic or breast attenuation (AU)