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1.
J Perioper Pract ; : 17504589221110332, 2022 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-35904049

RESUMEN

The aim of this study was to determine the rate of preoperative transthoracic echocardiography in hip fracture patients and to evaluate its effects on time to surgery and length of stay. We conducted a retrospective review of all patients with hip fractures treated at a tertiary referral hospital. Data examined included age, sex, comorbidities, time to surgery, length of stay, fracture type and transthoracic echocardiography findings. Forty-eight patients with hip fractures underwent surgery (men 41.7%; mean age 77.2 (49-95)). Nine patients (18.7%) had a preoperative transthoracic echocardiography. Preoperative transthoracic echocardiography was associated with a significantly longer time to surgery an abbreviation for days e.g dys should be added after the values to indicate what time frame is being measured (14.7 versus 6.8, p = 0.0051) and length of stay (23.6 versus 10.4, p = 0.0002). This study demonstrates a high rate of preoperative transthoracic echocardiography in hip fracture patients. The role of transthoracic echocardiography should be reassessed in view of its association with significant surgical delays.

2.
Case Rep Vasc Med ; 2022: 3595603, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35494098

RESUMEN

The median arcuate ligament compression syndrome is a rare entity that occurs in 2 per 100,000 unselected individuals. We present a case where the median arcuate ligament compression syndrome was associated with an equally uncommon anatomic variation-a celiac-mesenteric trunk, which occurs in 0.42-2.7% of unselected individuals. We could find no prior report of a celiac-mesenteric trunk being associated with the median arcuate ligament compression syndrome. This report also adds to the literature to show that a laparoscopic approach to median arcuate ligament release is feasible.

3.
Artículo en Inglés | PAHO-IRIS | ID: phr-55891

RESUMEN

[ABSTRACT]. Objective. To establish whether there was any difference in disease stage in patients with screening-detected colorectal cancer (CRC) in a Caribbean country. Methods. The mode of presentation (elective vs. emergent), method of diagnosis (screening vs. symptomatic), and disease stage were retrospectively compared in all consecutive patients who had resections for CRC over a five-year period. Early CRC was defined as disease that could be completely resected with no involvement of adjacent organs, lymph nodes, or distant sites. Locally advanced CRC was disease that involved contiguous organs without distant metastases that was still amenable to curative resection. Results. There were 97 patients at a mean age of 64.9 ± 12.2 years treated for CRC, and only 21 (21.6%) had their diagnoses made through screening. Significantly more screening-detected lesions were early-stage CRCs (21.7% vs. 9.3%; p < 0.001). At the time of diagnosis, patients who did not have screening-detected lesions had a greater proportion of locally advanced (42.3% vs. 0) and metastatic (26.8% vs. 0) CRC. Those who did not have screening-detected lesions had a greater incidence of emergency presentations at diagnosis (26.8% vs. 0). Conclusions. The incidence of screening-detected CRC in this Caribbean nation was low. Consequently, most patients presented with locally advanced or metastatic CRC, for which there is less opportunity to achieve a cure. Significantly more screening-detected lesions were early-stage CRCs. It is time for policymakers to develop a national CRC screening program.


[RESUMEN]. Objetivo. Determinar las diferencias en el estadio de la enfermedad en pacientes con cáncer colorrectal diagnosticado mediante un programa de detección sistemática en un país del Caribe. Métodos. Se realizó una comparación en retrospectiva de la modalidad de presentación (programada o de urgencia), el método de diagnóstico (por detección sistemática o por síntomas) y el estadio de la enfermedad en todos los pacientes consecutivos con resecciones por cáncer colorrectal en un período de cinco años. Se definió el cáncer colorrectal en fase inicial o incipiente como una enfermedad que puede extirparse completamente sin la afectación de los órganos adyacentes, los ganglios linfáticos o focos distantes. Se consideró el cáncer colorrectal localmente avanzado como una enfermedad que afecta a los órganos contiguos sin metástasis a distancia y aún susceptible de resección curativa. Resultados. Hubo 97 pacientes de una media de edad de 64,9 ± 12,2 años en tratamiento por cáncer colorrectal y únicamente 21 (21,6%) habían recibido un diagnóstico mediante un programa de detección sistemática. Un número significativamente mayor de los diagnósticos dados por detección sistemática se trató de cáncer colorrectal de fase inicial (21,7 % frente a 9,3 %; p < 0,001). En el momento del diagnóstico, se registró una mayor proporción de cáncer colorrectal localmente avanzado (42,3 % frente a 0) y metastásico (26,8 % frente a 0) en los pacientes sin lesiones diagnosticadas en un programa de detección sistemática. Los pacientes cuyas lesiones no fueron diagnosticadas mediante la detección sistemática registraron una mayor incidencia de presentaciones de urgencia en el momento del diagnóstico (26,8 % frente a 0). Conclusiones. La incidencia de cáncer colorrectal diagnosticado mediante detección sistemática en este país del Caribe fue baja. En consecuencia, la mayoría de los pacientes presentó cáncer colorrectal localmente avanzado o metastásico, cuya oportunidad de cura es menor. Un número significativamente mayor de lesiones diagnosticadas mediante detección sistemática se trató de cáncer colorrectal de fase inicial. Ha llegado el momento de que las personas responsables de las políticas elaboren un programa nacional de detección sistemática de cáncer colorrectal.


[RESUMO]. Objetivo. Determinar se houve diferença no estágio da doença detectada no exame de prevenção de câncer colorretal em um país do Caribe. Métodos. Fatores como tipo de apresentação (eletiva vs. de emergência), método de diagnóstico (prevenção vs. detecção sintomática) e estágio da doença foram comparados retrospectivamente em todos os pacientes consecutivos submetidos a cirurgia de ressecção de câncer colorretal em um período de cinco anos. Definiu-se doença em estágio inicial como o tumor passível de ressecção total sem o envolvimento de órgãos adjacentes, gânglios linfáticos ou sítios a distância, e doença localmente avançada como o tumor envolvendo órgãos contíguos, sem metástase a distância, mas passível de resseção curativa. Resultados. Noventa e sete pacientes com média de idade de 64,9 ± 12,2 anos foram tratados devido ao câncer colorretal e apenas 21 (21,6%) tiveram a doença diagnosticada no exame de prevenção. Um percentual significativamente maior de lesões detectadas no exame de prevenção estava em estágio inicial (21,7% vs. 9,3%; p < 0.001). No momento do diagnóstico, os pacientes cujas lesões de câncer colorretal não foram detectadas com o exame de prevenção apresentaram um maior percentual de doença localmente avançada (42,3% vs. 0) ou metastática (26,8% vs. 0). Houve também, entre esses pacientes, uma maior incidência de apresentação em caráter de emergência (26,8% vs. 0). Conclusões. Observou-se uma baixa incidência de câncer colorretal na população deste país do Caribe. Porém, a maioria dos pacientes apresentou doença localmente avançada ou metastática no diagnóstico – uma situação associada a uma menor chance de cura. O percentual de lesões detectadas em estágio inicial com o exame de prevenção foi significativamente maior. As autoridades de saúde devem aproveitar a oportunidade e instituir um programa nacional de prevenção do câncer colorretal.


Asunto(s)
Neoplasias Colorrectales , Barbados , Región del Caribe , Neoplasias Colorrectales , Región del Caribe , Neoplasias Colorrectales , Región del Caribe
4.
Rev Panam Salud Publica ; 46: e18, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35432501

RESUMEN

Objective: To establish whether there was any difference in disease stage in patients with screening-detected colorectal cancer (CRC) in a Caribbean country. Methods: The mode of presentation (elective vs. emergent), method of diagnosis (screening vs. symptomatic), and disease stage were retrospectively compared in all consecutive patients who had resections for CRC over a five-year period. Early CRC was defined as disease that could be completely resected with no involvement of adjacent organs, lymph nodes, or distant sites. Locally advanced CRC was disease that involved contiguous organs without distant metastases that was still amenable to curative resection. Results: There were 97 patients at a mean age of 64.9 ± 12.2 years treated for CRC, and only 21 (21.6%) had their diagnoses made through screening. Significantly more screening-detected lesions were early-stage CRCs (21.7% vs. 9.3%; p < 0.001). At the time of diagnosis, patients who did not have screening-detected lesions had a greater proportion of locally advanced (42.3% vs. 0) and metastatic (26.8% vs. 0) CRC. Those who did not have screening-detected lesions had a greater incidence of emergency presentations at diagnosis (26.8% vs. 0). Conclusions: The incidence of screening-detected CRC in this Caribbean nation was low. Consequently, most patients presented with locally advanced or metastatic CRC, for which there is less opportunity to achieve a cure. Significantly more screening-detected lesions were early-stage CRCs. It is time for policymakers to develop a national CRC screening program.

5.
Minim Invasive Surg ; 2022: 6781544, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35223097

RESUMEN

INTRODUCTION: Single incision laparoscopic surgery (SILS) is accepted as a safe alternative to conventional multiport laparoscopic (MPL) cholecystectomy for benign gallbladder disease. Since many surgeons carefully select patients without inflammation, there are limited data on SILS for acute cholecystitis. We report a single surgeon experience with SILS cholecystectomy for patients with acute cholecystitis. MATERIALS AND METHODS: After securing ethical approval, we performed an audit of all SILS cholecystectomies for acute cholecystitis by a single surgeon from January 1, 2009, to December 31, 2019. The following data were extracted: patient demographics, intraoperative details, surgical techniques, specialized equipment utilized, conversions (additional port placement), morbidity, and mortality. Data were analyzed using SPSS 12.0. RESULTS: SILS cholecystectomy was performed in 25 females at a mean age of 35 ± 4.1 (SD) years and a mean BMI of 31.9 ± 3.8 (SD) using a direct fascial puncture technique without access platforms. The operations were completed in 83 ± 29.4 minutes (mean ± SD) with an estimated blood loss of 76.9 ± 105 (mean + SD). Three (12%) patients required additional 5 mm port placement (conversions), but no open operations were performed. The patients were hospitalized for 1.96 ± 0.9 days (mean ± SD). There were 2 complications: postoperative superficial SSI (grade I) and a diaphragmatic laceration (grade III). No bile duct injuries were reported. There were 9 patients with complicated acute cholecystitis, and this sub-group had longer mean operating times (109.2 ± 27.3 minutes) and mean postoperative hospital stay (1.3 ± 0.87 days). CONCLUSION: The SILS technique is a feasible and safe approach to perform cholecystectomy for acute cholecystitis. We advocate a low threshold to place additional ports to assist with difficult dissections for patient safety.

6.
Trop Doct ; 52(1): 104-106, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34427133

RESUMEN

There is still no organised national screening programme for colorectal cancer in Jamaica. We sought to evaluate the detection of colorectal cancer precursor lesions in patients who underwent opportunistic screening over three years. Patients with colorectal polyps were selected for further study. In 431 procedures, there were 84 (19.5%) patients with colorectal polyps identified at screening colonoscopy, which gave a 19.5% sensitivity to identify patients with polyps at risk of developing colorectal cancer, 9.5% being <50 years of age. At the time of examination, 16.7% had already developed invasive adenocarcinoma. We conclude that it is time for policy makers to develop a national colorectal cancer screening programme to diagnose patients early and improve their therapeutic outcomes.


Asunto(s)
Colonoscopía , Neoplasias Colorrectales , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Detección Precoz del Cáncer/métodos , Humanos , Jamaica/epidemiología , Tamizaje Masivo/métodos
7.
Trop Doct ; 52(1): 101-103, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34474625

RESUMEN

When the COVID-19 pandemic unfolded in March 2020, surgical care was impacted globally. The developing nations in the Caribbean were unprepared with fragile, resource poor healthcare systems. A series of rapid policy changes in response to the pandemic radically changed surgical care and prevented the usual oversight in the operating theatre. Attending surgeons responded utilising readily available technology for distance mentoring. Using this model, postgraduate surgical residents were able to complete 96% of trauma laparotomies safely without major complications.


Asunto(s)
COVID-19 , Tutoría , Cirujanos , COVID-19/epidemiología , COVID-19/prevención & control , Humanos , Pandemias/prevención & control , SARS-CoV-2
8.
Cureus ; 13(10): e18739, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34790488

RESUMEN

Although advanced minimally invasive surgery and robotic surgery were well accepted in developed countries by the turn of the 21st century, they did not enjoy the same popularity in the Anglophone Caribbean. Advanced minimally invasive surgery only became available in select Caribbean countries from the year 2010. And up to the year 2021, robotic surgery was completely non-existent in the Anglophone Caribbean. Surgical leaders in the Anglophone Caribbean recognized a need to encourage the introduction of advanced surgical techniques in the region and engaged local and international stakeholders in an attempt to stimulate this development. In the year 2021, through a collaborative effort by a local medical university, a government-funded hospital, and industry partners in the United Kingdom, robot-assisted minimally invasive surgery was successfully introduced to the Caribbean. We report our experience of introducing robot-assisted minimally invasive surgery in the Eastern Caribbean. By discussing the pitfalls and successes from our experience, we hope that the lessons can be used to guide the introduction of robot-assisted minimally invasive surgery in other resource-poor countries in the Caribbean.​.

9.
World J Gastrointest Surg ; 13(10): 1122-1135, 2021 Oct 27.
Artículo en Inglés | MEDLINE | ID: mdl-34754382

RESUMEN

Pancreatic surgery has been one of the last areas for the application of minimally invasive surgery (MIS) because there are many factors that make laparoscopic pancreas resections difficult. The concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich countries. However, this is not the environment that many surgeons in developing countries work in. These patients often do not have the opportunity to travel to high volume centres for care. Therefore, we sought to review the existing data on MIS for the pancreas and to discuss. In this paper, we review the evolution of MIS on the pancreas and discuss the incorporation of this service into low-volume and resource-poor countries, such as those in the Caribbean. This paper has two parts. First, we performed a literature review evaluating all studies published on laparoscopic and robotic surgery of the pancreas. The data in the Caribbean is examined and we discuss tips for incorporating this operation into resource poor hospital practice. Low pancreatic case volume in the Caribbean, and financial barriers to MIS in general, laparoscopic distal pancreatectomy, enucleation and cystogastrostomy are feasible operations to integrate in to a resource-limited healthcare environment. This is because they can be performed with minimal to no consumables and require an intermediate MIS skillset to complement an open pancreatic surgeon's peri-operative experience.

10.
Radiol Res Pract ; 2021: 9201162, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34691781

RESUMEN

PURPOSE: There are many known variations in the arterial supply to the liver. We sought to document the incidence and details of anomalies of the extrahepatic arteries in an unselected population in the West Indies. METHODS: This study spanned 24 months. All 205 CT scans were evaluated at a hepatobiliary referral center in Trinidad and Tobago. We described the anomalies of the arterial supply to the liver using the conventional classification proposed by Michels. RESULTS: 205 CT scans were evaluated, and 112 persons (54.6%) had conventional Type 1 anatomy. However, compared to the incidence in the existing medical literature, we encountered a greater incidence of replaced right hepatic arteries (18.1% vs 11%; P 0.04) and a lower incidence of accessory right hepatic arteries (2.4% vs 7%; P 0.030). CONCLUSION: Although 54.6% of persons in this West Indian population have conventional hepatic arterial supply, the distribution of anatomic variants of the right hepatic artery is quite different to that seen in North American and European centers. We found a higher incidence of replaced right hepatic arteries and a lower incidence of accessory right hepatic arteries.

11.
Cureus ; 13(8): e16972, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34540383

RESUMEN

Major lower extremity amputations have been an area of much concern in the Caribbean population. Hence, the purpose of this research was to investigate the current trends in major lower-extremity amputations. Data regarding all major lower-extremity amputations performed at a tertiary care institution in Trinidad and Tobago, from January 2010 to December 2016 were reviewed. The variation of yearly trends, gender, type of amputation and reason for amputation were analysed. The yearly amputation rate demonstrated a progressive increase from 2010 to 2016, the average for the seven years was 28 per 105/year. Males accounted for 59% of cases, and 60% of amputations were done above the level of the knee joint. The most common reason for amputation was control of sepsis in 71.5% of cases. A strong association between major amputations and prior intervention for a foot-related problem was observed, as 52% of the sample had a pre-existing wound or a prior minor amputation (32%). Overall, 14.5% of all amputees were able to acquire a prosthesis. Diabetes mellitus was the most consistently associated co-morbidity occurring in 91% of the study population. Major limb amputations continue to affect our population significantly, with a rise in the amputation rate despite the introduction of a Vascular Surgical Unit. Diabetes and its foot-related complications are one of the leading causes of major lower extremity amputations. Prosthetic limb acquisition for our amputee population continues to be lacking, reflected by the low prosthetic acquisition rate observed.

12.
Prehosp Disaster Med ; 36(6): 797-802, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34556194

RESUMEN

This paper provides a field report on a hospital fire at the St. Jude hospital in the Eastern Caribbean Island of Saint Lucia. The hospital was completely destroyed by the fire and three deaths were recorded. This paper analyses the emergency response to this hospital fire and discusses the lessons learned from this experience. This is a valuable lesion for developing countries in the Caribbean, especially since there have been four hospital fires reported in the Caribbean within the past decade.


Asunto(s)
Incendios , Región del Caribe , Hospitales , Humanos , Santa Lucia , Indias Occidentales
14.
Cureus ; 13(6): e15489, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34268021

RESUMEN

During damage control laparotomy, surgery is abbreviated to allow for the correction of physiologic disturbances, with a plan to return to the operating theatre for definitive surgical repair. Re-entry into the abdomen is facilitated by temporary abdominal closure (TAC). Skin-only closure is one of the many techniques described for TAC Numerous sources advise against the use of this technique because of the risk of complications. This case report describes the use of skin-only closure during a damage control laparotomy. We reviewed the literature surrounding the various options for TAC to elucidate the potential role of skin-only closure after damage control laparotomy.

15.
Cureus ; 13(6): e15460, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34258122

RESUMEN

Background In the classic descriptions of the human liver, the umbilical fissure (UF) is a long, narrow groove on the visceral surface that receives the ligamentum teres hepatis. In this study, we document the UF variations encountered in a series of cadaveric dissections. Methods We reported UF variations using the following classification: Type I refers to "normal" anatomy where there is a long, narrow groove. In type II, the UF was covered by a fibrotic band devoid of hepatic parenchyma. In type III variants, an extension of hepatic parenchyma partially covered but did not obliterate the UF. In type IV variants, the hepatic parenchyma formed a bridge over the UF, completely obliterating the groove. After institutional review board approval, we observed all consecutive cadaveric dissections over five years and recorded the characteristics and dimensions of each UF and its immediate relations. Results There were 69 cadavers, and variant UFs were present in 38 (55.1%) cadavers: type II (1.5%), type III (20.3%), and type IV (33.3%). Conclusions In this Jamaican population, only 44.9% of persons had conventional "normal" anatomy and 55.1% had UF variants. These variants are clinically significant, as they lead to misinterpretation of patient imaging and can hinder operative procedures on the liver.

16.
World J Gastrointest Endosc ; 13(6): 170-183, 2021 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-34163564

RESUMEN

BACKGROUND: In the classic descriptions of the human liver, the common hepatic duct forms at the confluence of left and right hepatic ducts. Many authors have documented variations in the intra-hepatic ductal system, but to the best of our knowledge there has been no report on bile duct variations in Caribbean populations. AIM: To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography (MRC) in unselected patients at a major hepatobiliary referral centre in the Eastern Caribbean. Knowledge of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary disorders. METHODS: This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern Caribbean. We retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1, 2017 to March 31, 2019. Two consultant radiologists experienced in MRC interpretation reviewed all scans and described biliary anatomy according to the Huang's classification. A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary variant. The variants in our population were compared to the global population. RESULTS: There were 152 MRCs evaluated in this study in 86 males and 66 females. There were 109 (71.7%) persons with "classic" biliary anatomy (type A1) and variants were present in 43 (28.3%) persons. There was no statistical relationship between the presence of anatomic variants and gender or ethnicity. We encountered the following variants: 29 (19.1%) type A2, 7 (4.6%) type A3, 6 (3.95%) type A4, 0 type A5 and a single variant (quadrification) that did not fit the classification system. Compared to the global prevalence, our population had a significantly greater occurrence of A1 anatomy (71.7% vs 62.6%; P = 0.0227) and A2 trifurcations (19.1% vs 11.5%; P = 0.0069), but a significantly lower incidence of A3 variants (4.61% vs 11.5%; P = 0.0047). CONCLUSION: There are significant differences in intra-hepatic biliary anatomy in this unselected Eastern Caribbean population compared to global statistics. Specifically, persons of Caribbean descent have a greater incidence of Huang A2 trifurcations and a lower incidence of Huang A3 variants.

17.
World J Transplant ; 11(6): 231-243, 2021 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-34164298

RESUMEN

BACKGROUND: Variations in the anatomy of hepatic veins are of interest to transplant surgeons, interventional radiologists, and other medical practitioners who treat liver diseases. The drainage patterns of the right hepatic veins (RHVs) are particularly relevant to transplantation services. AIM: The aim was to identify variations of the patterns of venous drainage from the right side of the liver. To the best of our knowledge, there have been no reports on RHV variations in in a Caribbean population. METHODS: Two radiologists independently reviewed 230 contrast-enhanced computed tomography scans performed in 1 year at a hepatobiliary referral center. Venous outflow patterns were observed and RHV variants were described as: (1) Tributaries of the RHV; (2) Variations at the hepatocaval junction (HCJ); and (3) Accessory RHVs. RESULTS: A total of 118 scans met the inclusion criteria. Only 39% of the scans found conventional anatomy of the main hepatic veins. Accessory RHVs were present 49.2% and included a well-defined inferior RHV draining segment VI (45%) and a middle RHV (4%). At the HCJ, 83 of the 118 (70.3%) had a superior RHV that received no tributaries within 1 cm of the junction (Nakamura and Tsuzuki type I). In 35 individuals (29.7%) there was a short superior RHV with at least one variant tributary. According to the Nakamura and Tsuzuki classification, there were 24 type II variants (20.3%), six type III variants (5.1%) and, five type IV variants (4.2%). CONCLUSION: There was significant variation in RHV patterns in this population, each with important relevance to liver surgery. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.

18.
J Orthop Case Rep ; 11(2): 67-70, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34141674

RESUMEN

INTRODUCTION: Total knee replacement (TKR) utilization is expected to increase by 673% in 2030, with patients between the ages of 45 to and 64 years representing the fastest-growingfastest growing age group requiring joint replacement. This group not only demands a higher- performinghigher performing, durable prosthesis but are is also the most likely to be dissatisfied if their expectations are not met. Hypo-allergenic implants have been developed by some implant manufacturers to fill this need, so the occurrence of allergic skin reactions after surgery is unanticipated and can have unwanted consequences if not recognized and managed appropriately. CASE REPORT: We present the case of a 55-year-old woman who underwent bilateral staged TKR using oxidized zirconium implants and subsequently developed eczematous skin reactions. In both instances, she presented with a peri-incisional erythematous blistering skin reaction that was successfully treated with topical corticosteroids. Investigations revealed no evidence of infection or allergic-typeallergic type reactions to the metals contained in the knee replacements. CONCLUSION: Allergic skin reactions following TKR are very rare, and are not necessarily due to a metal hypersensitivity. Infection must be excluded in all cases and a trial of topical corticosteroids is useful before prior to more aggressive treatment, with the removal of the implant reserved as a last resort. To the best of our knowledge, this is the first case in the literature that reports the occurrence of allergic skin reactions following oxidized zirconium TKRs, and highlights the fact that allergic skin reactions can occur when using hypo-allergenic implants. Surgeons should be aware of this possibility and counsel their patients appropriately during the informed consent process.

19.
Trop Doct ; 51(4): 539-541, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34162285

RESUMEN

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.


Asunto(s)
Colecistectomía Laparoscópica , Colecistitis Aguda , Región del Caribe , Colecistectomía , Colecistectomía Laparoscópica/efectos adversos , Colecistitis Aguda/cirugía , Humanos , Tiempo de Internación , Factores de Tiempo , Resultado del Tratamiento
20.
Cureus ; 13(5): e14891, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-34109080

RESUMEN

There has been no prior report of single-incision laparoscopic surgery (SILS) from the Caribbean island of Turks and Caicos. We report our initial experience with SILS cholecystectomy to show that SILS in this environment is feasible with minimal change to the existing hardware. It is a safe alternative to conventional multi-trocar laparoscopic cholecystectomy in this setting.

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