Caroli's Disease Associated with a Gastric Diverticulum

Caroli's disease or communicating ectasia of the intrahepatic biliary tree is a rare disease with unknown aetiology. The coexistence of this along with the uncommon condition of a gastric diverticulum has never been reported before. A deficiency in the fibromuscular matrix of both the bile ducts and the gastric wall may explain why these two pathologies may coexist in a single patient.

Caroli's Disease Associated with a Gastric Diverticulum

Caroli's disease or communicating ectasia of the intrahepatic biliary tree is a rare disease with unknown aetiology. The coexistence of this along with the uncommon condition of a gastric diverticulum has never been reported before. A deficiency in the fibromuscular matrix of both the bile ducts and the gastric wall may explain why these two pathologies may coexist in a single patient. (AU)

Antenatal screening for HIV in North Trinidad. Demographic characteristics of patients, acceptability of testing and the rising prevalence of infection - Poster abstract

OBJECTIVE: To ascertain the acceptability of HIV screening in pregnancy and the prevalence of HIV in pregnant women in north Trinidad. DESIGN AND METHOD: All women attending an antenatal clinic at the Port of Spain General Hospital were offered HIV testing at booking. Written consent was obtained after testing counselling and blood samples were tested using an ELISA assay with positive results confirmed by western blot. Demographic data were also collected. HIV positive women/infant pairs were tested using a modified CDC - Thailand regime. RESULTS: A total of 338 new patients were seen between March and November 1999 of whom only 8 refused testing. Ten patients tested positive giving a prevalence of 3 percent. All of the HIV positive patients were of African or mixed race descent which reflected the population attending this clinic. CONCLUSION: Our data indicated a slowly rising prevalence of HIV in pregnant women in north Trinidad. The majority of patients (98 percent) easily accept screening.(AU)

A study of admissions to Ward 1, Port of Spain General Hospital for early pregnancy loss: May-June 1999 - Poster abstract

OBJECTIVE: To compare early pregnancy loss in spontaneous versus induced abortions and determine the most common methods of pregnancy termination. DESIGN AND METHODS: In this prospective study, 205 patients admitted to Ward 1, Port of Spain General Hospital from May 1 to June 31, 1999 were interviewed with respect to age and circumstances surrounding thier pregnancy loss. Patient records were subsequently examined to obtain results of investigations and medical or surgical interventions undertaken. RESULTS: Patient were placed into 3 groups: spontaneous abortions (SA), induced abortions (1A) (all types) and mosprostol-induced abortions (MA). Patients' ages ranged from 14 to 43 years (mean 25 years). Length of hospital stay ranged from 1 to 24 days (mean 2.1 days). There was no difference in patient age or length of hospital stay among the three groups. Patients in the MA group exhibited increased rates of sepsis (53.7 percent vs 34.5 percent in the SA group), more episodes of blood transfusion (18.5 percent, MA vs 8.8 percent, SA) and had a higher rate of incomplete abortions (79.8 percent, MA vs. 59.0 percent SA). This led to an increased need for surgical intervention (72.2 percent, MA vs 49.1 percent, IA). Patients in the SA group display intermediate values in all parameters. CONCLUSIONS: Self-medication with Misoprostol is by far the most popular method of termination of unwanted pregnancy in this population. It was associated with increased rates of sepsis, anaemia and necessity for surgical evacuation of the uterus when compared with IA in the same population.(AU)

Chlamydia trachomatis antibody and DNA determination in ectopic pregnancy in Trinidad

OBJECTIVE: To determine the prevalence of C. trachomatis in ectopic pregnancy by serum IgG and IgM antibody and by chlamydia DNA in endometrial, Fallopian tube and ovarian tissues. DESIGN AND METHODS: A cross-sectional study included 32 women presenting with tubal ectopic pregnancy and 94 fertile controls. Methods employed were ELISA for IgG and IgM and Polymerase Chain Reaction (PCR) and in situ hybridization (ISH) for DNA. RESULTS: Chlamydial IgG and IgM antibody detection was higher in the ectopic than the control groups (IgG, p<0.01; IgM, p<0.01). A similar finding was also noted for chlamydia DNA by PCR (p<0.05). DNA detection was also significantly higher at each site in the upper genital tract (endometrium p<0.01, Fallopian tube p<0.05, ovary p<0.05). CONCLUSION: By antibody detection, this study confirms the role played by genital tract C. trachoma infection and subsequently ectopic pregnancy, but more importantly, identifies chlamydial DNA in upper genital tract tissues. These results support allocation of resources towards screening programmes for C. trachomatis.(Au)

Sphincter saving procedures in low rectal cancer - abstract

Radical resection for rectal cancer has not improved survival over the past 50 years, and leaves the patient with the permanent burden of a colostomy. Methods of sphincter conservation, evolved over the past decade, achieve the same level of control of disease locally and do not impair survival. In view of this, a policy of sphincter conservation was prospectively adopted since 1983 for low rectal tumours: 33 consecutive cases were managed, of which 12 had local excision; 9 abdomino-anal pull through and 12 low anterior resections were performed. There were 2 local recurrences treated by abdomino-perineal resection and one anastomotic leak which healed with stricture formation. One patient had persistent mild faecal soiling. Sphincter conservation is safe and effective, and should be considered the treatment of choice in the management of low rectal cancer (AU)

Routine drainage in thyroid surgery: is this practice obsolete? - abstract

Thyroid surgery without drainage is thought by many surgeons to be a practice with potentially catastrophic consequences. This thinking which evolved from the late nineteenth century view of absolute prescription of thyroidectomy because of bleeding has been questioned in recent papers. Our experience at surgery also led us to doubt the necessity of routine drainage, and so, since 1976, we practised non-drainage prospectively in 248 consecutive thyroidectomies. Subtotal lobectomy was done in 56 cases, unilateral lobectomy in 115 and bilateral subtotal thyroidectomy in 77 cases. This is the largest such series reported to date. In only one case was drainage considered necessary, and the only complication attributable to non-drainage was minor subcutaneous fluid collection (2 cases). In thyroid surgery, following meticulous haemotasis, routine drainage is not necessary (AU)

Gall bladder disease in Trinidad

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 Caucasians in the United Kingdom, United States and Sweden. The female to male ratio (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)

Gall bladder disease in Trinidad

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)

Mesenteric venous thrombosis and oral contraceptive use

A case of mesenteric venous thrombosis in a young woman receiving oral contraceptives is reported. This is the first case encountered in the Caribbean region. (Au)

Actinomycosis of the liver

We present our first case of actinomycosis in Trinidad and we believe this is also the first reported case of hepatic actinomycosis in the West Indies.(AU)

Oesophagectomy without thoracotomy

Oesophagectomy without thoracotomy has been recommended by some surgeons because of minimal morbidity and mortality associated with this procedure. This is the first report from the West Indies on the use of this technique. We recommended the procedure because of the numerous advantages it offers over oesophagectomy via a thoracotomy (AU)

Carcinoma of the colon in an adolescent

A case of carcinoma of the colon in childhood is reported, There was remarkable absence of gastro-intestinal symptoms. Reasons for the poor prognosis in this condition are discussed as well as the possibilities for improving survival (AU)

Epidemiology of urinary calculi - abstract

Clinicians have frequently note the high incidence of urolithiasis in Trinidad. The purpose of the study was to examine the reasons for this and evaluate the possible roles of various factors (e.g. age, race, sex, water intaked, diet and occupation). Three hundred and three (303) patients, seen at the Port of Spain General Hospital during the period 1974 - 1980 were studied. Patients ranged in age from 9 - 76 with an average of 38 years. There were 153 Negroes, 122 Indians and 28 others. Males accounted for 175 cases and females for 128. Of the calculi 189 were renal, 91 ureteric, 35 bladder and 1 urethral. There were more calculi on the right (146) than the left urolithiasis is rather uncommon in the American Negro and the African Bantu, it is relatively common in the Trinidad Negro. The age distribution in Indian and Negro populations was the same and was similar to that reported from India and Africa. However, the sex ratio in these 2 groups was quite different from that seen in Africa (M: F = 4) and India (M: F = 2.6:1). Although there is marked variation in the calcium content of water from various parts of Trinidad (2.8 - 13.1mg percent) there was no clustering of cases in the areas of higher calcium concentration. This is consistent with findings in other places. (Frankd et al, 1959). There was no definite correlation between dietary habits and the incidence of urolithiasis. The role of occupation is more difficult to assess because of the selection of patients coming to hospital (AU)

Gastric carcinoma - abstract

Gastric carcinoma, the commonest cause of death from malignant disease in Trinidad, accounts for about 100 deaths annually. There has been a steady decrease in incidence of this condition over the past 10 years - a trend noted in many countries including the U.S.A. and Jamaica. Although a male to female ratio of 2 - 3:1 is common, it is only 1.2: in our population, the disease being sufficiently common among females to rank third as a cause of death due to malignancy. The highest incidence is between the ages 60 - 75. As in other populations the commonest clinical features are weight loss (90 percent), anorexia (84 percent) and vomiting (76 percent). In over 80 percent of patients tumour spread at the time of diagnosis or treatment contributes to a poor prognosis. It may affect any age, sex or race but its predeliction for the negro of the lower income group (over 80 percent) suggests that genetic and environmental factors may be important. This prediposition of the negro had also been noted in the United States though gastric carcinoma is quite uncommon in Africa. Elucidation of possible aetiologic factors may assist in further decreasing the incidence while greater suspicion and easy availability of diagnostic methods should result in improved survival from this common condition (AU)