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1.
Trop Doct ; 30(4): 214-6, Oct. 2000. tab
Artigo em Inglês | MedCarib | ID: med-129

RESUMO

Twenty-seven children aged 18 years and under with homozygous sickle-cell disease had open cholecystectomy for symptomatic gallstones over the 12 year period 1985-1997. Emergency procedures (done during period of acute exacerbation of symptoms) were performed on 16 patients. Four with haemoglobin levels greater than 1g/dl below their steady state received a simple blood transfusion preoperatively designed to raise haemoglobin levels to 10g/dl. All had acute or acute on chronic cholecystitis based on histological examination of gallbladder specimens. Twelve had common bile duct stones. In two patients calculi were missed intraoperatively but these subsequently passed into the duodenum after a period saline irrigation via an in-situ t-tube. Six developed the acute chest syndrome (aetiology not determined) and this progressed to multi system failure and death in one. This high level of postoperative mobility and mortality may in part be due to the high proportion of emergency procedures. (AU)


Assuntos
Criança , Feminino , Humanos , Masculino , Adolescente , Anemia Falciforme/complicações , Bem-Estar da Criança/estatística & dados numéricos , Colecistostomia/estatística & dados numéricos , Colelitíase/epidemiologia , Colelitíase/cirurgia , Colecistostomia/mortalidade , Colelitíase/etiologia , Tratamento de Emergência , Jamaica/epidemiologia , Prevalência
2.
J Pedriatr ; 136(1): 80-5, Jan. 2000.
Artigo em Inglês | MedCarib | ID: med-749

RESUMO

The prevalence, incidence, risk factors, clinical associations, and morbidity of gallstones were studied in 311 patients with homozygous sickle cell disease and 167 patients with sickle cell-hemoglobin C disease in a cohort study from birth. Gallstones developed in 96 patients with homozygous sickle cell disease and 18 patients with sickle cell-hemoglobin C disease; specific symptoms necessitating cholecystectomy occurred in only 7 patients with homozygous sickle cell disease.(AU)


Assuntos
Adulto , Criança , Humanos , Masculino , Feminino , Adolescente , Anemia Falciforme/epidemiologia , Colelitíase/epidemiologia , Doença da Hemoglobina SC/epidemiologia , Anemia Falciforme/genética , Anemia Falciforme/mortalidade , Colecistectomia , Colelitíase/complicações , Colelitíase/cirurgia , Estudos de Coortes , Seguimentos , Doença da Hemoglobina SC/mortalidade , Homozigoto , Incidência , Jamaica/epidemiologia , Vigilância da População , Prevalência , Fatores de Risco , Taxa de Sobrevida
3.
In. Gray, Robert H. Management guidelines in paediatrics for the Caribbean. Kingston, Canoe Press University of the West Indies, 1998. p.46-58, tab.
Monografia em Inglês | MedCarib | ID: med-1453
4.
WEST INDIAN MED. J ; 46(Suppl. 2): 18, Apr. 1997.
Artigo em Inglês | MedCarib | ID: med-2329

RESUMO

Although many authors view laparoscopic cholecystectomy as the treatment of choice for gallstones there is evident that it has probably caused more deaths and major postoperative morbidity than open cholecystectomy. The Medical Defence Union has reported increased claims for bile duct injury from laparoscopic cholecystectomy (LC). The technology is expensive and not readily available in third world countries. Because minilaparotomy cholecystectomy (MC) also minimally invasive and offers similar advantages to LC we studied it prospectively and report our experience. MC was performed in 160 consecutive patients through a 4.8 cm (3 - 6 cm) incision, with operating time of 35 minutes (18 - 80 ). No major ductal injury and no reoperation occurred. Patients were discharged after 38 hours (range 16 - 60 hours). The operating time is much shorter, hospital stay and postoperative morbidity similar to LC. Review of the world literature shows no clear advantage of LC over MC. Because MC is cheap, effective, requires no specialised training or expensive equipment and can be done by any competent surgeon in most hospitals in the developing world, we recommend it as treatment of choice for gall stones in the third world. (AU)


Assuntos
Humanos , Colecistectomia Laparoscópica , Colelitíase/cirurgia , Ductos Biliares/cirurgia , Países em Desenvolvimento
5.
J Pediatr ; 130(3): 394-9, Mar. 1997.
Artigo em Inglês | MedCarib | ID: med-2034

RESUMO

OBJECTIVE: To describe the characteristics of salmonella infections in sickle cell disease and to compare the features of osteomyelitis and those with bacteremia/septicemia without obvious bone changes. To search for risk factors for osteomyelitis, and to draw attention to the frequency and significance of salmonella bacteremia/septicemia. STUDY DESIGN:A retrospective review of all salmonella isolations from the blood, pus, or aspirates during a 22-year period. SETTING: The sickle cell clinic at the University Hospital of the West Indies, Kingston, Jamaica. SUBJECTS: Patients with all genotypes of sickle cell diseases. Incidence data and the frequency of associated cholelithiasis were derived for the cohort study based on follow-up of all children detected by neonatal screening. MAIN OUTCOME MEASURES: Osteomyelitis and bacteremia/septicemia. RESULTS: Of 55 patients with salmonella infections, 25 initially had osteomyelitis and 27 had bacteremia/septicemia. Three of the first group later had bacteremias for a total of 30 episodes of bacteremia/septicemia, and 4 of the second group later had osteomyelitis for a total of 32 episodes of osteomyelitis. The incidence of salmonella infection was 8.6 percent by 15 years and 96 percent of infections occurred before the age of 10 years. Preceding episodes of avascular necrosis of bone were frequent (p < 0.006) in patients with osteomyelitis. Patients with osteomyelitis were not more prone to gallstones. High fever (temperature > or = 40 degrees C or 104 degrees F) occurred in 41 percent, and occasionally marked bone marrow suppression mimicked the aplastic crisis. Twenty Salmonella serotypes were isolated; Salmonella enteritidis accounted for 36 percent of infections, but no serotype difference occurred between those with osteomyelitis and those with bacteremia/septicemia. There were no deaths in the 32 patients with osteomyelitis, but 7 (23 percent) of 30 patients with septicemia died. CONCLUSIONS: Anti-salmonella prophylaxis requires assessment in the management of bone necrosis. Anti-salmonella agents may be indicated in undiagnosed septic conditions in sickle cell disease pending culture results.(AU)


Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Bacteriemia/microbiologia , Anemia Falciforme/complicações , Osteomielite/microbiologia , Infecções por Salmonella/complicações , Anemia Falciforme/epidemiologia , Bacteriemia/epidemiologia , Colelitíase/complicações , Colelitíase/epidemiologia , Estudos de Coortes , Incidência , Jamaica/epidemiologia , Osteomielite/epidemiologia , Osteonecrose/complicações , Osteonecrose/epidemiologia , Fatores de Risco , Salmonella enteritidis/isolamento & purificação , Infecções por Salmonella/epidemiologia , Esplenectomia
7.
J Pediatr ; 129(3): 443-5, Sept. 1996.
Artigo em Inglês | MedCarib | ID: med-2988

RESUMO

Biliary sludge was observed in the gallbladder in 17 of 429 patients in a cohort study of sickle cell disease. Discrete gallstones later developed in 12 patients, but no stones developed in five patients; one patient with biliary sludge had no change in his condition for 5 years. None of the patients with biliary sludge had any symptoms referable to the biliary tract, and cholecystectomy has not been performed. The Jamaican experience suggests that biliary sludge may be treated conservatively, similar to our approach to asymptomatic gallstone. (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Pré-Escolar , Adolescente , Bile , Anemia Falciforme/complicações , Anemia Falciforme/genética , Colelitíase/etiologia , Talassemia beta/complicações , Talassemia beta/genética , Genótipo , Doença da Hemoglobina SC/complicações , Doença da Hemoglobina SC/genética , Homozigoto , Prognóstico
9.
West Indian med. j ; 45(suppl. 2): 19, Apr. 1996.
Artigo em Inglês | MedCarib | ID: med-4645

RESUMO

Fifty-eight patients with homozygous sickle-cell disease had cholecystectomy for symptomatic gallstones between January 1986 and September 1995 at the University Hospital of the West Indies and the Bustamante Hospital for Children, Jamaica. Top-up blood transfusion was administered to 7 patients with haemoglobin levels > lgm/dl below their steady state values. Complications related to the presence of biliary calculi were cholecystitis (58), common bile duct (CBD) dilatation (20), gallbladder empyema (2), and gallstone ileus (1). Nine developed the acute chest syndrome post-operatively leading to death in two patients. Three had retained CBD stones, which passed into the duodenum after a trial of saline irrigation via an in-situ t-tube. Because pre-operative ultrasonography is an unrelialbe modality for detecting CBD stones and also because of the high presence of CBD stones in sickle-cell disease, routine operative cholangiography is recommended at the time of surgery (AU)


Assuntos
Humanos , Anemia Falciforme/cirurgia , Colelitíase/cirurgia , Colecistectomia
10.
West Indian med. j ; 43(suppl.1): 13, Apr. 1994.
Artigo em Inglês | MedCarib | ID: med-5441

RESUMO

The clinical details of 17 patients aged 18 years and under with homozygous sickle-cell disease (SS) who presented with gallstone-related symptoms to the University Hospital of the West Indies, and the Bustamante Hospital for Children are analysed. All patients had right upper quadrant signs pre-operatively and all were confirmed to have acute or chronic cholecystitis based on gallbladder (GB) histology. Other gallstone-related complications were obstructive jaundice in 2, mucocoele of the GB in 1 and GB empyema in 1. While 16 of 17 had gallstones detected preoperatively ultrasound, only 2 of 6 patients later confirmed to have common bile duct (CBD) stones, were also detected. One patient had retained CBD stones post-operatively which were successfully dislodged by saline irrigation via t-tube. There was no mortality but 3 patients developed the acute chest syndrome, 4, unexplained pyrexia and 1, wound abscess. We believe that gallstone-related morbidity in children with SS disease may so far be underestimated. Even the youngest develop life-threatening complications. The risk of associated choledocholithiasis and obstructive complications may be just as high in paediatric SS disease patients with gallstones as in adults similarly affected (AU)


Assuntos
Humanos , Criança , Adolescente , Criança , Colelitíase , Anemia Falciforme/complicações , Febre , Jamaica
11.
Blood Rev ; 7(3): 137-45, Sept. 1993.
Artigo em Inglês | MedCarib | ID: med-8343

RESUMO

Sickle cell disease is enormously variable in its expression and outcome. In addition to this intrinsic variablity are the problems of symptomatic selection biasing observations towards the sever end of a wide clinical spectrum and a truly changing natural history as a result of better management. Against this background, there was a need for a description of the disease in a truly representative sample of patients and this objective has been approached in the Jamaican Cohort Study of Sickle Cell Disease. Initiated in 1973, this study is based on all cases of sickle cell disease detected among 100,000 consecutive normal deliveries in Kingston, Jamaica. All affected children as well as age matched normal controls have been followed prospectively and are currently ages 11 to 19 years. The following review is based on lessons learnt from this cohort study. It is not intended to be a comprehensive survey of knowledge of sickle cell disease and does not address major contributions from studies elsewhere. In some ways, therefore, the review may appear unbalanced because of this specific objective. However, a great deal has been learnt about the evolution of the abnormal haematology of sickle cell disease and its relationship to clinical features. The causes of early mortality in sickle cell disease in Jamaica are described and the major complications such as acute splenic sequestration, pneumococcal septicaemia, aplastic crisis, hypersplenism, and acute chest syndrome have been addressed with varying success. Overall survival to the age of 19 years has been 75 percent and it is planned that the study should continue to define the problems of late adolescence and early adult life (AU)


Assuntos
Humanos , Masculino , Feminino , Anemia Falciforme/terapia , Anemia Aplástica/etiologia , Anemia Falciforme/sangue , Anemia Falciforme/complicações , Anemia Falciforme/mortalidade , Causas de Morte , Transtornos Cerebrovasculares/etiologia , Colelitíase/epidemiologia , Colelitíase/etiologia , Estudos de Coortes , Deficiência de Ácido Fólico/etiologia , Transtornos do Crescimento/etiologia , Incidência , Infecções/complicações , Jamaica/epidemiologia , Infecções por Parvoviridae/complicações , Estudos Prospectivos , Doenças Retinianas/etiologia , Esplenopatias/etiologia , Esplenopatias/mortalidade , Taxa de Sobrevida , Doenças Torácicas/etiologia , Doenças Torácicas/mortalidade
12.
West Indian med. j ; 41(3): 116-9, Sept. 1992.
Artigo em Inglês | MedCarib | ID: med-15669

RESUMO

Gallstone ileus is a rare cause of mechanical bowel obstruction. The attendant lack of awareness by the clinician will not only result in the diagnosis being made intraoperatively but will also affect the adequacy of the preoperative preparation of these ill patients. These patients are often elderly, septic and have significant concomitant medical illnesses. Recently two patients with gallstone ileus were managed with enterolithotomy and primary repair of the cholecyst-duodenal fistula at the University Hospital of the West Indies, Jamaica. Their clinical presentations and progress are described along with a review of the classical clinical course, radiological features, and operative choices available. (AU)


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Feminino , Fístula Biliar/cirurgia , Colelitíase/complicações , Duodenopatias/cirurgia , Doenças da Vesícula Biliar/cirurgia , Fístula Intestinal/cirurgia , Obstrução Intestinal/etiologia , Fístula Biliar/complicações , Colecistectomia , Colelitíase/cirurgia , Duodenopatias/complicações , Duodeno/cirurgia , Fístula Intestinal/complicações , Obstrução Intestinal/cirurgia
13.
West Indian med. j ; 41(3): 96-8, Sept. 1992.
Artigo em Inglês | MedCarib | ID: med-15674

RESUMO

The results of biliary surgery are reported in 12 consecutive patients with homozygous sickle-cell (SS) disease treated over a two-year period at the University Hospital of the West Indies, Kingston, Jamaica. Recommendations for the surgical management of these patients are outlined


Assuntos
Humanos , Criança , Adolescente , Adulto , Masculino , Feminino , Anemia Falciforme/complicações , Colecistectomia , Colelitíase/cirurgia , Estudos Retrospectivos , Colelitíase/etiologia
14.
West Indian med. j ; 41(2): 61-3, June 1992.
Artigo em Inglês | MedCarib | ID: med-9637

RESUMO

Thirty-five patients with chronic pancreatitis (CP) treated with over a 15-year period were studied. There were 29 men and 6 women with a mean age of 47 years (range 21-67). Twenty-seven (77 percent) were chronic alcoholics, two (6 percent) had gallstones, one had stenosis of the Ampulla of Vater and in five (14 percent) no obvious cause was found. Thirty patients (86 percent) presented with abdominal pain. Chronic diarrhoea was present in 8 (23 percent), and steatorrhoea was documented in 6 of these. Fifteen (43 percent) had pancreatic calcifications. Five developed pseudocysts and 16 (46 percent) developed diabeted mellitus. Twelve patients required surgery. Three continue to have severe recurrent relapses of pain but the majority (91 percent) have had a relatively stable course with medical management. (AU)


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Pancreatite , Jamaica , Alcoolismo/complicações , Dor Abdominal/etiologia , Colelitíase/complicações , Doença Crônica , Testes de Função Pancreática , Pancreatite/complicações , Pancreatite/terapia , Fatores de Tempo
15.
West Indian med. j ; 38(Suppl. 1): 21, Apr. 1989.
Artigo em Inglês | MedCarib | ID: med-5704

RESUMO

Gallstones were detected by ultrasonography in 30/226 (13 per cent) children with SS disease, aged 5-13 years, participating in a cohort study from birth. Children with gallstones had significantly lower total haemoglobin and foetal haemoglobin and higher bilirubin levels. Further analysis revealed that the apparent effects of Hb and HbF were secondary to their relationship with bilirubin levels. Abdominal pain crises were significantly associated with gallstones but both factors appeared to reflect an increased clinical severity and were probably not casually related. No patient had symptoms specific for gallstones. An association with abdominal pain crisis should not, of itself, be considered an indication for surgery (AU)


Assuntos
Humanos , Criança , Anemia Falciforme , Colelitíase/diagnóstico por imagem , Dor Abdominal , Bilirrubina
16.
Artigo em Inglês | MedCarib | ID: med-17108

RESUMO

In Trinidad, cholecystectomy is now the most common elective intra-abdominal operation performed by the general surgeon. A review of 220 patients shows that gall bladder disease affects our population at a much younger age (average 43.8 years) than that reported for Caucasisans in the United Kingdom, United States and Sweden. The female to male ration (8.6:1) is one of the highest reported. There is no race predisposition to the disease, which is evenly distributed between the two major ethnic groups represented in the population. In this population, first pregnancy at an early age and multiparity seem to be the important factors which predispose the young female to cholelithiasis(AU)


Assuntos
Humanos , Colecistectomia , Colelitíase/diagnóstico , Colelitíase/cirurgia , Trinidad e Tobago , Região do Caribe , Colelitíase
19.
Am J Hematol ; 3: 15-21, 1977.
Artigo em Inglês | MedCarib | ID: med-10350

RESUMO

The prevalence of cholelithiasis in Jamaican adults with SS disease was studied by plain abdominal radiograph in 206 patients and by oral cholecystogram in 126 (61 percent) of these patients. Gallstones were found in 57 (28 percent of patients, were more common in females than males, and increased with age and hemolytic rate. The majority of gallstones were visible on the plain abdominal radiograph, only 17 percent of patients with gallstones having only radiolucent stones. Nonfunctioning oral cholecystograms were common (10 percent) in agreement with observations by previous workers. Gallstones were noted in the common bile duct in 2 patients. In general there was no clear relationship between the presence of cholelithiasis and clinical symptomatology. Complications, such as pancreatitis and malignant change in the gall bladder, recognized to be associated with cholelithiasis in the general population, have not been clearly related to cholelithiasis in SS disease. More information is needed before a logical policy can be evolved for surgical intervention in cholelithiasis in SS disease. (AU)


Assuntos
Humanos , Masculino , Feminino , Anemia Falciforme/complicações , Colelitíase/complicações , Envelhecimento , Colelitíase/sangue , Colelitíase/diagnóstico por imagem , Jamaica
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