Necrotizing Fasciitis: Myalgia Is Diagnostic? A Case Series and Literature Review.

Necrotizing fasciitis, commonly known as "flesh-eating disease," is an aggressive soft tissue infection that destroys the fascia, subcutaneous tissue, and skin. Specific clinical features (crepitus or radiologic features of gas in tissues) either appear late or are of poor sensitivity. Thus, a high index of clinical suspicion is required for early diagnosis and prompt treatment, which are the best methods of minimizing its high associated morbidity and mortality. We present 3 cases to demonstrate diagnostic difficulties and challenges in management and highlight the feature of pain on muscular activity.

Accessory Inferior Sulci of the Liver in an Afro-Caribbean Population.

INTRODUCTION: There have been no previous reports on the anatomic variations that exist on inferior surface of the liver in Caribbean populations. This information is important to optimize radiology and hepatobiliary surgical services in the region. METHODS: Two investigators independently observed 69 cadaveric dissections over five years and described the variations in surface anatomy. RESULTS: In this population 88% of cadaveric livers had conventional hepatic surface anatomy. However, 12% had accessory sulci present on the visceral surface of the liver, with a 7:1 male preponderance. When present, there was 100% correlation between the presence of Rouvière's sulcus and the right branch of portal pedicle. CONCLUSION: Abnormal surface anatomy is present in 12% of unselected specimens in this Caribbean population. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.

Epidemiology of tetanus in Jamaica, 1993–2010

BACKGROUND: Although tetanus is still endemic in Jamaica, the epidemiologic profile has not been evaluated. METHODS: Admission registers at the main tertiary referral hospital were accessed to identify all patients diagnosed with tetanus from 1 January 1993 to 1 December 2010. RESULTS: There were 26 cases of tetanus (annual incidence of 0.57 cases per 1,000,000 population). Tetanus was more common in men (5.2:1) at a mean age of 59 ± 18.1 years. Persons in high-risk occupations (farmers, gardeners and construction workers) accounted for 52% of cases. CONCLUSION: Tetanus remains endemic in Jamaica, occurring more commonly in elderly men. Doctors should be educated about the importance of a high index of suspicion, an immunisation history and promoting booster shots in high-risk groups.