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1.
Spine (Phila Pa 1976) ; 48(15): E247-E254, 2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-36763835

RESUMO

STUDY DESIGN: Biomechanical study. OBJECTIVE: To demonstrate that robotic cervical traction can apply closed cervical traction as effectively as manual weight-and-pulley traction in extension spring and cadaveric models. SUMMARY OF BACKGROUND DATA: Closed cervical traction is used to reduce subaxial cervical spine dislocation injuries and to distract the intervertebral space during cervical spine surgery. Weight-and-pulley cervical traction relies on cumbersome and imprecise technology without any safeguard to prevent over-traction or weights being pulled/released inadvertently. METHODS: A prototype robotic traction device was designed and manufactured by the authors with real-time tensile force measurement, ±1-lbs (5 N) force application accuracy, locking/non-backdriveable linear actuators with actuator position sensing, 200-lbs (900 N) maximum force capability, up to 20° of flexion/extension manipulation, <25-lbs (111 N) device weight, and compatibility with Gardner-Wells tongs or Mayfield head clamp. The device was tested using an extension spring model and an intact fresh cadaver specimen to assess applied and desired force over time and radiographic changes in the cervical spine as traction force increased. The cadaver was tested in manual traction initially and then robotic traction in 10-lbs (50 N) increments up to 80-lbs (355 N) to compare methods. RESULTS: The prototype device met or exceeded all requirements. In extension spring testing, the device reached the prescribed forces of both 25-lbs (111 N) and 80-lbs (355 N) accurately and maintained the desired weight. In cadaveric testing, radiographic outcomes were equivalent between the prototype and manual weight-and-pulley traction at 80-lbs (355 N; disk space measurements within ±10% for all levels), and the device reached the desired weight within±1-lbs (5 N) of accuracy at each weight interval. CONCLUSION: This preliminary work demonstrates that motorized robotic cervical traction can safely and effectively apply controlled traction forces.


Assuntos
Procedimentos Cirúrgicos Robóticos , Traumatismos da Coluna Vertebral , Humanos , Pescoço , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Vértebras Cervicais/lesões , Cadáver , Tração/métodos , Fenômenos Biomecânicos
2.
J Racial Ethn Health Disparities ; 10(2): 844-858, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-35266120

RESUMO

OBJECTIVE: Breast cancer is the leading cause of cancer affecting women worldwide. The survival rate is primarily affected by the stage of the disease and several other demographic and clinicopathological factors. METHODS: This study is a retrospective cohort study of female patients of the University Hospital of the West Indies diagnosed with breast cancer between 2011 and 2016. The age, tumor size, SBR/Nottingham grade, tumor histologic subtype, tumor molecular subtype, and survival status of the cohort on November 1, 2019, were determined. The data were summarized. Survival across each variable was compared using univariate log-rank tests, Cox proportional hazard models, and crude and adjusted models. A second wave analysis was performed excluding patients whose survival status was presumed. RESULTS: A total of 503 patients were analyzed. The overall survival rate at 1, 3, and 5 years were 96.4%, 84.9%, and 79.0%, respectively, for the entire cohort. The molecular subtype was the most significant clinicopathological factor affecting overall survival. A younger age < 40 years, higher histologic grade, estrogen receptor-negative breast cancers, invasive ductal type breast cancers, and T1 lesions were associated with poorer survival outcomes at 5 years. The findings were reproduced after a second wave analysis excluding patients who were presumed alive was applied. CONCLUSIONS: Breast cancer overall survival in Jamaica is consistent with that of other developing countries in the literature. This study is an important contribution to the growing body of literature available and aids to the overall understanding of the behavior of breast cancer locally.


Assuntos
Neoplasias da Mama , Feminino , Humanos , Adulto , Neoplasias da Mama/diagnóstico , Estudos Retrospectivos , Jamaica/epidemiologia , Modelos de Riscos Proporcionais , Índias Ocidentais , Taxa de Sobrevida
3.
BMC Womens Health ; 21(1): 176, 2021 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892714

RESUMO

BACKGROUND: Breast cancer is the leading cause of cancer and cancer related deaths in Jamaican women. In Jamaica, women often present with advanced stages of breast cancer, despite the availability of screening mammography for early detection. The utilization of screening mammography for early breast cancer diagnosis seems to be limited, and this study investigated the national patterns of mammographic screening and the impact of mammography on the diagnosis of breast cancer in Jamaica. METHODS: A retrospective analysis of the records of the largest mammography clinic in Jamaica was done for the period January 2011 to December 2016. Descriptive statistics was performed on relevant patient characteristics with calculation of rates and proportions; cross-tabulations were utilized to assess relationship of covariates being studied on the outcomes of interest. Results are reported in aggregate form with no identifiable patient data. RESULTS: 48,203 mammograms were performed during the study period. 574 women (1.2%) had mammograms suspicious for breast cancer with median age of 57 years (range 30-95 years); 35% were under the age of 50. 4 women with suspicious findings had undergone 'screening mammography', with the remaining having 'diagnostic mammography'. 38% reported previous mammograms, with a mean interval of 8 years between previous normal mammogram and mammogram suspicious for breast cancer. Median age at first screening mammogram was 51 years (range 41-77). CONCLUSION: Breast cancer screening mammography is underutilized in Jamaica. An organized national breast cancer screening programme is recommended to improve adherence to international breast cancer screening guidelines.


Assuntos
Neoplasias da Mama , Mamografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Detecção Precoce de Câncer , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Anat Sci Educ ; 12(1): 32-42, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29603656

RESUMO

Research suggests that spatial ability may predict success in complex disciplines including anatomy, where mastery requires a firm understanding of the intricate relationships occurring along the course of veins, arteries, and nerves, as they traverse through and around bones, muscles, and organs. Debate exists on the malleability of spatial ability, and some suggest that spatial ability can be enhanced through training. It is hypothesized that spatial ability can be trained in low-performing individuals through visual guidance. To address this, training was completed through a visual guidance protocol. This protocol was based on eye-movement patterns of high-performing individuals, collected via eye-tracking as they completed an Electronic Mental Rotations Test (EMRT). The effects of guidance were evaluated using 33 individuals with low mental rotation ability, in a counterbalanced crossover design. Individuals were placed in one of two treatment groups (late or early guidance) and completed both a guided, and an unguided EMRT. A third group (no guidance/control) completed two unguided EMRTs. All groups demonstrated an increase in EMRT scores on their second test (P < 0.001); however, an interaction was observed between treatment and test iteration (P = 0.024). The effect of guidance on scores was contingent on when the guidance was applied. When guidance was applied early, scores were significantly greater than expected (P = 0.028). These findings suggest that by guiding individuals with low mental rotation ability "where" to look early in training, better search approaches may be adopted, yielding improvements in spatial reasoning scores. It is proposed that visual guidance may be applied in spatial fields, such as STEMM (science, technology, engineering, mathematics and medicine), surgery, and anatomy to improve student's interpretation of visual content. Anat Sci Educ. © 2018 American Association of Anatomists.


Assuntos
Anatomia/educação , Sinais (Psicologia) , Ocupações em Saúde/educação , Resolução de Problemas/fisiologia , Estudantes de Ciências da Saúde/psicologia , Desempenho Acadêmico/estatística & dados numéricos , Compreensão/fisiologia , Estudos Cross-Over , Movimentos Oculares/fisiologia , Feminino , Humanos , Masculino , Navegação Espacial/fisiologia , Estudantes de Ciências da Saúde/estatística & dados numéricos , Fatores de Tempo , Percepção Visual/fisiologia
5.
Ann Med Surg (Lond) ; 5: 52-6, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26862396

RESUMO

OBJECTIVE: To determine the quality of surgical management offered to patients with colorectal cancer (CRC) as measured by adequacy of nodal resections and compare variations across the major hospitals in Jamaica. METHOD: Data was obtained from the CRC Registry of patients diagnosed and treated surgically for CRC during the 3-year period commencing January 1, 2011. Variables analyzed included tumor site, stage and number of lymph nodes resected across hospitals. RESULTS: During the period under review 60% (349) of 586 patients had resections and formed the basis of this study. Of these 49% were treated at the UHWI, 27% from the KPH and STH, 15% from CRH and MRH and 8% from a private laboratory (DPS). Patient distribution was similar at UHWI compared to the others with mean age (61 vs 62) and with slightly more women having surgery (53% Vs 54%) (UHWI vs Others). For tumor grade, margin status, lymphovascular and depth of invasion (majority T3) there was no difference between UHWI and the other sites, although a smaller percentage of tumors treated at UHWI had Crohn's like reaction (p = 0.01). There was a larger proportion of sigmoid cancer at UHWI while the reverse trend was seen in cancers of the rectum (p = 0.027). The tumors treated at UHWI have a larger median number of regional nodes when compared to the other facilities (14 vs 10; p < 0.001) and also more likely to have positive nodes, as were women and younger patients. Comparison across facilities revealed that the proportion of tumors classed as well differentiated, circumferential margin involvement, and having lymphovascular invasion were higher for specimens processed at the private facility (p = 0.021, 0.035, 0.01 respectively). Histopathology reports of tumors treated at UHWI and DPS had median 14 and 18 nodes respectively while at NPH laboratory and CRH they were 9 and 10 respectively (p < 0.001), whilst those of the ascending, descending, sigmoid colon and rectum had median 15, 11, 13, 11 nodes respectively (p < 0.001). CONCLUSIONS: This review demonstrates measurable differences in the surgery and histopathological reports for CRC patients treated across the island. Given adjuvant treatment and prognostic implications there is room for improvement.

6.
Ann Med Surg (Lond) ; 6: 26-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26870324

RESUMO

OBJECTIVE: To determine the intermediate and long-term survival of patients diagnosed with colorectal cancer (CRC) and to determine factors that affect survival. METHOD: Patients were identified from a prospectively maintained colonoscopy database. All patients who underwent colonoscopy during the period January 2008 to December 2012 and had histologically confirmed invasive carcinoma were included. These patients were contacted at the end of 2013 to determine their survival status. In addition to demographics, variables analyzed included presenting complaint and tumor site and stage at presentation. RESULTS: Of 1757 patients being subjected to colonoscopy, 118 had endoscopic and histologic documentation of invasive CRC. Of these the survival status of 102 was determined as of December 2013 and they formed the basis of our study. The mean age of the group was 62 years with approximately 20% of the group being age 50 years or younger. Females (54%) slightly outnumbered males. Anemia or overt rectal bleeding was a dominant indication (44%) and 65% of the tumours were left sided. There were 58 (57%) deaths and the median overall survival time was two years post diagnosis. Log rank tests for equality of survivorship looking at age, gender, tumor site and presentation revealed that only presenting complaint was a predictor of survivorship (p < 0.001). Patients presenting with bleeding or anemia have the best survival. CONCLUSIONS: Long-term survival from colorectal cancer remains poor with only about 33% of patients being alive five years after their diagnosis.

7.
Otolaryngol Head Neck Surg ; 152(3): 571-3, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25616770

RESUMO

Advanced skin malignancies involving the temporal bone can involve the temporomandibular joint and glenoid fossa. Many of these tumors can be removed with a lateral temporal bone resection; however, extensive involvement of the glenoid fossa should include an en bloc resection of the temporal bone, glenoid fossa, and condyle. We describe a novel surgical approach that is an extension of a temporal bone resection that includes the glenoid fossa and condyle in an en bloc resection with the temporal bone. This procedure has been performed in 7 patients with advanced carcinoma of the temporal bone involving the glenoid fossa. There were no short-term complications as a result of the surgical approach. The addition of a middle fossa craniotomy and inclusion of the glenoid fossa and condyle as part of an en bloc resection of the temporal bone can be performed safely.


Assuntos
Craniotomia/métodos , Neoplasias Cranianas/cirurgia , Osso Temporal/cirurgia , Articulação Temporomandibular/cirurgia , Seguimentos , Humanos , Estadiamento de Neoplasias , Neoplasias Cranianas/diagnóstico , Osso Temporal/patologia , Articulação Temporomandibular/patologia , Resultado do Tratamento
8.
Perm J ; 15(1): 57-61, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21505620

RESUMO

In an era of technology-dependent surgery, Jamaica and other developing countries must deal with the wide disparity between their surgical practices and those of developed nations. Although there is still a place for the well-trained surgeon, the current emphasis in developed nations is less on the individual surgeon and more on the surgery team and system, with increasing costs despite diminishing government support. At the University of the West Indies, we are challenged to continue providing appropriate service and training for the Caribbean region, but we hope that a combination of fellowship-trained team leaders and partnerships with resource-rich institutions will enable us to meet this challenge and to meet the health care needs of our populace.

9.
BMC Surg ; 10: 6, 2010 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-20152019

RESUMO

BACKGROUND: During a previous study to define and compare incidence risks of postoperative nausea and vomiting (PONV) for elective laparoscopic and open cholecystectomy at two hospitals in Jamaica, secondary analysis comparing PONV risk in elective open cholecystectomy to that after emergency open cholecystectomy suggested that it was markedly reduced in the latter group. The decision was made to collect data on an adequate sample of emergency open cholecystectomy cases and further explore this unexpected finding in a separate study. METHODS: Data were collected for 91 emergency open cholecystomy cases identified at the two participating hospitals from May 2007 retrograde, as was done for the 175 elective open cholecystectomy cases (from the aforementioned study) with which the emergency cases were to be compared. Variables selected for extraction and statistical analysis included all those known, suspected and plausibly associated with the risk of PONV and with urgency of surgery. RESULTS: Emergency open cholecystectomy was associated with a markedly reduced incidence risk of PONV compared to elective open cholecystectomy (6.6% versus 28.6%, P < 0.001). The suppressive effect of emergency increased after adjustment for confounders in a multivariable logistic regression model (odds ratio 0.103, P < 0.001). This finding also identifies, by extrapolation, an association between reduced risk of PONV and preoperative nausea and vomiting, which occurred in 80.2% of emergency cases in the 72 hour period preceding surgery. CONCLUSIONS: The incidence risk of postoperative nausea and vomiting is markedly decreased after emergency open cholecystectomy compared to elective open cholecystectomy. The study, by extrapolation, also identifies a paradoxical association between pre-operative nausea and vomiting, observed in 80.2% of emergency cases, and suppression of PONV. This association, if confirmed in prospective cohort studies, may have implications for PONV prophylaxis if it can be exploited at a sub-clinical level.


Assuntos
Colecistectomia/efeitos adversos , Colecistectomia/métodos , Náusea e Vômito Pós-Operatórios/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
J Med Case Rep ; 1: 15, 2007 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-17475007

RESUMO

We present a 61 year old Para 4 woman who presented with stage II Infiltrating lobular carcinoma of the breast after modified radical mastectomy. She was treated with Tamoxifen for seven years. She was diagnosed with multiple myeloma during year seven post mastectomy because of wrist pain. She was treated with melphalan, prednisone and allopurinol which she tolerated well and the pain in the wrist improved. Tamoxifen was also stopped. Ten months later she presented with vaginal bleeding and was diagnosed with a poorly differentiated endometrial adenocarcinoma at hysteroscopic suction curettage and had an abdominal hysterectomy. Two years later the patient succumbed to metastatic endometrial cancer.

11.
West Indian med. j ; 49(3): 242-4, Sept. 2000. graf
Artigo em Inglês | LILACS | ID: lil-291983

RESUMO

A case of chronic relapsing pancreatitis presenting in an 8-year old African Jamaican girl is outlined. Aggressive supportive management failed to control pain and vomitting. The Puestow Procedure effectively aborted these symptoms. The use of the Puestow procedure should not be inordinately delayed in chronic relapsing pancreatitis if symptoms persist, since it may not only control pain but also halt declining pancreatic function.


Assuntos
Criança , Feminino , Humanos , Ductos Pancreáticos , Pancreatite , Drenagem , Jamaica
12.
West Indian med. j ; 45(3): 85-8, Sept. 1996.
Artigo em Inglês | LILACS | ID: lil-180085

RESUMO

This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.


Assuntos
Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Colecistectomia Laparoscópica/efeitos adversos , Dor Pós-Operatória , Colecistectomia Laparoscópica/economia , Estudo de Avaliação
13.
West Indian med. j ; 44(4): 146-7, Dec. 1995.
Artigo em Inglês | LILACS | ID: lil-165468

RESUMO

A case of obstructive jaundice secondary to a neurofibroma in the common hepatic duct is presented. The histological appearance was that of a plexiform neurofibroma. The clinicopathological features are discussed


Assuntos
Adulto , Feminino , Humanos , Neoplasias dos Ductos Biliares/patologia , Colestase/etiologia , Neurofibroma Plexiforme/patologia , Neurofibroma Plexiforme/cirurgia , Ducto Hepático Comum
14.
West Indian med. j ; 43(3): 104-6, Sept. 1994.
Artigo em Inglês | LILACS | ID: lil-140352

RESUMO

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


Assuntos
Humanos , Adulto , Masculino , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/terapia , Abscesso/diagnóstico , Abscesso/terapia , Prognóstico , Emergências , Laminectomia
15.
West Indian med. j ; 43(3): 107-9, Sept. 1994.
Artigo em Inglês | LILACS | ID: lil-140353

RESUMO

One case of atherosclerotic gluteal artery aneyrysm (GAA) is presented. The diagnosis was made pre-operatively, and treatment involved ligation and division of the internal iliac artery only. This therapeutic option is discussed as the perferred one compared to the conventional two-step procedure


Assuntos
Humanos , Idoso , Feminino , Nádegas/irrigação sanguínea , Aneurisma/cirurgia , Ultrassom , Aneurisma/diagnóstico , Aneurisma/etiologia
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