An analysis of acute intestinal obstruction

250 cases of acute intestinal obstruction treated at the University Hospital over a ten year period were analysed. The incidence of the various causes of obstruction have been recorded. The overall mortality was 8.4 percent. The single most important factor contributing to this mortality was delay in diagnosis and operation. (AU)

Cysto-urethrography in the University Hospital of the West Indies

Cysto-urethrography was performed on 100 patients with complicated urethral stricture and the findings were correlated at operation. In this series, the indications for cysto-urethrography were impassable strictures, strictures requiring frequent dilatations, or the presence of septic complications including peri-urethral fistulae. The technique of cysto-urethrography was performed initially by the use of metal cannulae and later by the use of a foley type, self-retaining catheter. Water soluble contrast media were used and an attempt was made to obtain both ascending and descending cysto-urethrograms in each case. The value of the descending examination is stressed. Analysis of the 100 cases revealed strictures in 97, and fistulae without strictures in 3 cases. Most of the strictures were solitary and occurred in the bulbous urethra. Fistulae originated in the urethra in 30; other complications are listed. By comparison with other series it appears that in many countries, traumatic stricture is becoming more common than inflammatory stricture; this is not the case in developing countries like Jamaica. In the present series most of the strictures were inflammatory in origin. The high incidence of complications, especially fistulae, is thought to result from the initial treatment of stricture by repeated bouginage with secondary infection. (AU)

Adenoid cystic carcinoma of the breast

The rarity of this tumor has already been mentioned, but it is interesting that at a seminar attended by about 1,000 pathologists the collective experience was of only 25 adenoid cystic tumors of the breast. The tumor is histologically indistinguishable from adenoid cystic carcinoma occurring in the salivary glands, in the mucous glands of the trachea, bronchi, and, rarely, in cutaneous sweat glands. Although tumors at these sites do metastasize, the clinical course is prolonged . As far as we know, there is only one recorded instance of metastasis from this type of breast tumor. This occurred in a patient who, eight years after radical mastectomy for a "cylindroma," developed metastases. In spite of respiratory insufficiency, this patient survived an additional five years (AU)

Acute intestinal obstruction in Jamaica

In the 650 patients with acute intestinal obstruction treated in the past 11 years at the University College Hospital of the West Indies in Jamaica, obstruction due to hernia, adhesions, or intussusception occurred in 2 of every 3 patients. Obstructions due to malignant lesions were infrequently seen and those due to diverticulitis and mesentric vascular occlusion were not encountered. The overall mortality rate was 8.4 per cent. Gangrenous obstructions were associated with a high mortality. Strangulated abstructions, in which intestinal resection was unnecessary, were attended by a lower mortality than simple obstruction. The most important factors influencing mortality were found to be the age of the patient, the mortality being highest at the extremes of life, and the duration of the delay in seeking medical attention.(Summary)

Arteriovenous fistula

The etiology, pathological physiology, clinical features and management of arteriovenous fistula are discussed. Three illustrative case reports are presented (AU)

Non-penetrating pancreatic trauma

The pathogenesis and management of trauma to the pancreas as a result of non-penetrating injury are discussed, and two illustrative cases presented (AU)

Adreno-genital syndrome

Three cases due to congenital adrenal hyperplasia were presented: a 33 months old girl with abnormal genitalia since birth, a male infant salt loser presented at 3 weeks of age with evidence of adreno-cortical insufficiency and a 45 year old female pseudo-hermaphrodite (AU)

Adrenalectomy and cortisone in advanced breast cancer

A series of 20 patients treated with cortisone and 19 treated by adrenalectomy were studied. It was concluded that the favourable response to adrenalectomy in some of these patients was related to factors other than the administration of corticoids (AU)

Suppurative soft tissue infection of the head and neck

Antibiotics have modified the frequency and severity of seosis in the head and neck and continue to play the major role in therapy. Surgical treatment is of importance in decompressing sepsis in closed spaces in order to abort the additional tissue destruction which occurs from avascularity, in limiting the spread of infection and in terminating infection once suppuration has occurred. To be effective surgical intervention must be properly timed. Incisions should be large enough to accomplish adequate drainage and should be so placed as to minimize the resultant scarring. An understanding of the surgical anatomy of this area is essential in the management of these problems. Mention has been made of spread to the carotid sheath and down this sheath into the mediastinum. Carotid arterial and internal jugular venous thrombosis as well as suppurative pericarditis have been illustrated with case reports. The possibility of fatal haemorrhage from carotid arterial erosion has been mentioned. Suppurative infection in the head and neck is potentially lethal. The dangers of suppuration involving the face and lips have been re-emphasized and the possibilities of cavernous sinus thrombophlebitis and bilateral central retinal artery thrombosis have been recorded. Crepitant non-clostridial cellulitis has been discussed and attention has been drawn to the dangers of sub-aponeurotic infection of the scalp. The association of suppurative thyroiditis with carcinoma of the larynx has been once more recorded (AU)