Splenic flexure volvulus

Splenic flexure volvulus is rare, only 22 cases having been reported. Though these usually present with chronic intermittent clinical features we recently encountered a case presenting as acute intestinal obstruction which, on plain abdominal x-rays, had classical features of this condition.(AU)

Benign breast disease in a West Indian population

A review of 1726 breast lesions in West Indian women from Trinidad showed that the pattern of disease is significantly different from athat reported in whites but similar to reports from India and Africa. This difference is mainly due to the high frequency of fibro-adenoma in our adolescent women. Fibro-adenoma was the commonest lesion (39.3 per cent), followed by mammary dysplasia (32 per cent) and carcinoma (21 per cent). Although carcinoma comprised only 21 per cent of all breast lesions, nearly 40 per cent of true neoplasms were malignant. We believe all suspicious breast lumps in Black women need biopsy and further analysis of morphological components of benign breast lesions is neccessary to evaluate precursors to cancer of the breast.(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)

Familial bilateral multiple fibroadenomas of the breast

This paper describes multiple breast fibroadenomas in three siblings. It appears that the familial disorder seen is associated with bilateral multiple fibroadenomas.(AU)

Idiopathic granulomatous orchitis

A case of granulomatous orchitis in a 52-year old negro male is reported. The distinction between granulomatous orchitis and cancer is important in particular in coloured people where the former is not rare while testicular cancer is uncommon.(AU)

Thyroid disease in Trinidad

A 5-year review of 460 consecutive thyroidectomy specimens showed goitrous hyperplasia to be the commonest thyroid disease in Trinidad. The incidence of thyrotoxicosis (19) percent is higher than that reported from India and Africa, whereas the occurrence of cancer (4 percent) is one of the lowest reported.(AU)

Infarction of fibroadenoma of the breast

Although infarction is an infrequent complication of a fibroadenoma, its recognition is important since it has been mistaken for carcinoma. Awareness of the lesion as well as careful evaluation of gross and microscopic findings will help to differentiate it from carcinoma. The pathogenesis of this complication is unclear.(AU)

Rhinosporidiosis in Trinidad

Five cases of rhinosporidiosis are reported for the first time from Trinidad and Tobago. All patients were males. The conjunctiva was the site of the lesion in four cases, the nose in one case (AU)

Dirofilariasis of the breast

Sections of an adult filarial worm, probably Dirofilaria tenuis or related species were found within the breast tissue. This is the first human dirofilarial infection reported from Trinidad.(AU)

Breast disease in young West Indian women: an analysis of 1051 consecutive cases

Our analysis of 1051 breast biopsies in West Indian women under the age of 30 y revealed that 99 percent of the breast lumps were benign. Fibroadenoma was the commonest (67 percent) lesion and there was a steady increase in the frequency of fibrocystic disease with age. Carcinoma in this group is therefore rare. Thus most patients can be reassured with certainty of their benign disease and have biopsy at a convenient time.(AU)

The acquired immune deficiency syndrome in Trinidad. A report on two cases

Two cases of the acquired immune deficiency syndrome are reported from Trinidad. Both patients were male homosexuals who had opportunistic infections. One had disseminated infection with cryptococcus neoformans and the other with toxoplasma gondii. This is the first report of the syndrome from the Commonwealth Caribbean (AU)

Colorectal carcinoma in Trinidad - abstract

Colorectal cancer is the fifth commonest cause of death from malignancies in Trinidad. Data available from the Ministry of Health and the Central Statistical Office in the 10-year period 1969-1978 provided 620 cases for analysis. In addition, 152 confirmed cases from the Port-of-Spain General Hospital were reviewed. The mortality rate for cancer of the colon was 4.4 per 100,000 of population with an increasing trend over the 10-year period. The mortality rate for rectal cancer was 1.8 per 100,000 of population with a decreasing trend. The average age of diagnosis was 64.3 years with rapidly rising incidence with advancing age. The M: F ratios are 1 : 1.05 and 1.1 : 1 for cancer of the colon and rectum respectively. There was a higher incidence in the Black, Chinese and Christian communities and a lower incidence in the East Indian, Hindu and Muslim communities. The Chinese had lesions predominantly on the left and the East Indians on the right side of the colon and in the rectum. The negroes had a more even distribution of the lesions. Only 51.6 percent of the lesions were in the rectum and sigmoid colon and 7.4 percent of the cancers were multiple. A relatively high percentage of Stage IV cases (39 percent) was encountered, with a correspondingly low resectability rate (67 percent) and high incidence of intestinal obstruction (29.9 percent). Fortunately, in the later years of the study, more early cancers and less Stage IV lesions had been diagnosed. The increasing incidence of colon cancer demands that a higher index of suspicion with more liberal use of barium enema and sigmoidoscopic examinations be employed in order to make earlier diagnosis and deliver prompt treatment (AU)

The teenager's breast lump: to cut or not to cut? - abstract

The presence of a breast lump, in any age group, raises the possibility of malignancy and, as a result, it has been suggested that all solid descrete lesions in the breast be excised. Since breast masses are quite common in teenage West Indian women and breast carcinoma in this group is very rare, we thouht it necessary to examine this policy to early excision in our population. Of 2,642 consecutive breast biopsies (1976-1982), 658 (24.5 percent) were in teenage girls. All lumps were benign in this age group. Fibroadenoma was the commonest lesion (77.6 percent). For fibroadenoma, clinical diagnostic accuracy was 92 percent; in the 8 percent that were misdiagnosed, the histological findings were always benign. Fourteen per cent of patients with fibroadenoma either had previous excision or returned with recurrences during the study period. An initial conservative policy in our teenagers with clinically benign breast masses will result in minimising the number of operations by: (a) avoiding surgery in most patients with fibroadenosis; (b) performing a single operation in many patients with "recurrent: or multiple fibroadenomas, and (c) avoiding surgery where spontaneous regression of fibroadenomas occurs. Minimising the number of breast operations has clear economic benefits while, in a population prone to hypertrophic scarring and keloids, there are cosmetic advantages. A conservative policy is not likely to increase the risk of missing malignancies because clinical diagnostic accuracy is high in this age group and we have not encountered teenagers with breast carcinoma. Among West Indian teenagers, routine observation of clinically benign breast disease needs to be considered as the management of choice (AU)

Retroperitoneal exclusion vs transperitoneal aneurysmorraphy for abdominal aortic aneurysms - abstract

Blood loss, fluid and electrolyte imbalance, prolonged paralytic ileus and respiratory problems all contribute to the morbidity and mortality in patients having abdominal aortic aneurysmorraphy. Our experience, using a new technique of "extraperitoneal exclusion", shows that the morbidity and blood transfusiion requirements are less than in conventional transperitoneal exclusion", shows that the morbidity and blood transfusion requirements are less than in conventional transperitoneal aneurysmorraphy. Comparison of 18 exclusions with 12 transperitoneal cases shows a lower blood loss, shorter hospital stay, less paralytic ileus and respiratory complications in the former group. In a developing country, such as ours, with limited intensive care facilities, blood bank stores and hospital beds, aneurysmorraphy by this exclusion technique needs to be considered as the method of choice in patients with aorto-iliac aneurysms (AU)

Myocutaneous flaps and the West Indian general surgeon - abstract

Although myocutaneous flaps are not yet widely used in the West Indies, their use has facilitated reconstructive surgery in difficult cases. Because many of our patients present with advanced disease and since multidisciplinary teams are usually unavailable, these reliable flaps could be very valuable. From November 1983 to 1987, we have performed 30 flaps in 29 cases. There were 18 rectus abdominis flaps for primary (9) or recurrent (8) breast cancer, or necrotising fascitis (1); in this group, there was 1 partial (10 percent) loss and 1 total loss of the graft. Seven gastrocnemius grafts were done for tibial non-union (3), osteomyelitis (2) or traumatic soft tissue loss (2); there were 4 latissimus dorsi, and 1 trapezius, grafts. Primary healing was achieved in all the cases except the two abdominal flaps. Unlike the traditionally used tubed-skin flap, the musculo-cutaneous flap can be performed at one operation. The excellent vascularity also helps the graft to withstand radiotherapy and resist infection. Thus, use of a myocutaneous flap permits wide resection of tumour or generous debridement of infected tissue with immediate reconstruction in one stage. Its high success rate, with primary healing, makes it an extremely valuable tool in the armamentarium of the West Indian general surgeon (AU)

Breast cancer in Trinidad - abstract

Breast cancer is one of the commonest malignancies in the Trinidadian woman. A 7-year study of breast biopsies from 2,642 women shows that 20 per cent of the lesions biopsied were malignant. Patients with cancer were from 23 to 92 yrs, with a peak prevalence in the 45-60 yr. age group. The age-specific rate increased steadily with age. Most patients were multiparous; 92 per cent of them had breast-fed their children. Fifty-one per cent had stage 1 disease; 76 per cent had infiltrating duct carcinoma; 7.0 per cent scirrous, 2.7 per cent medullary, 1.6 per cent mucoid and 1.3 per cent Paget's Disease of the nipple; other less common carcinomas accounted for the remainder. The high rates of multiparity and breastfeeding in our patients with breast cancer are unusual associations with this disease. Our high incidence of infiltrating duct carcinoma is consistent with many studies; this type is usually linked to a poor prognosis. Education of the public on breast and its associated epidemiological factors could result in more patients presenting with stage 1 disease (AU)

Segmental infarction of the omentum: diagnosis by ultrasound - case report

Pre-operative diagnosis of segmental infarction of the omentum is difficult because of its rarity and non-specific clinical features. We present a case of omental infarction and suggest that ultrasound scan may be helpful in the diagnosis of this entity (Summary)

Granular cell myoblastoma of the breast

Five cases of granular cell myoblastoma of the breast are reported, all occuring in Negroes. In none was the correct diagnosis made preoperatively. Because this benign tumor has many features of carcinoma, errors in clinical and mammographic assessment may lead to unnecessary mastectomy. Thus, a histological diagnosis must be made on every apparently malignant lump before any form of definitive therapy is performed (Summary)

Massive ascites due to omental endometriosis

Endometriosis associated with massive ascites is an unusual combination. Only 12 cases have been reported since its first description by Brews in 1954. The authors report the first case where radical surgery was avoided because of successful hormonal therapy.(Summary)

Mesenteric venous thrombosis and oral contraceptive use

A case of mesenteric venous thrombosis in a young woman receiving oral contraceptives is reported. This is the first case encountered in the Caribbean region. (Au)