Penetrating trauma to the neck

Penetrating injuries to the neck can cause threatening injuries and damage to many vital structures. Injury patterns associated with penetrating neck trauma are multiple and varied ranging from soft tissue injury to spinal cord transection. Without hard clinical signs such as stridor, dysphagia, or an expanding hematoma, the diagnosis of vital structure injury can be difficult. In the presence of clinically subtle signs or minimal symptoms, adjunctive modalities such as angiography, endoscopy and oesophagography have increased the accuracy in diagnosing these injuries. The routine use of these modalities remains controversial. A retrospective review was performed of 18 patients with penetrating trauma to the neck, evaluated by the Trauma Service of Morehouse School of Medicine, Department of Surgery from July 1994 to July 1997. The injury patterns of the 17 patients who survived more than twenty-four hours were evaluated. Nine patients (53 percent) had injuries to vital structures within the neck, which included: spinal cord injury (3): vascular injury (3); oesophageal injury (1); tracheal injury (1); thyroid cartilage injury (1); and hyoid bone fracture (1). Seven patients had neck explorations and three had no evidence of vital structure injury. Eight patients were evaluated with panendoscopy. Six of these had negative studies, and the two patients with positive studies had injuries noted prior to endoscopy which required operative intervention. Ten patients had oesophagrams which were all negative, and vascular injuries were detected in three of the six patients in whom this procedure was undertaken. The mean hospital stay for all patients was 14.8 days, but this was longer for patients with neck injuries (22.9 days) than for those without neck injury (5.8 days). The average length of stay in the Intensive Care Unit was 6.24 days. Patients with neck injuries had a mean length of stay of 11.6 days compared to those without neck injury whose mean stay was less than one day. In conclusion: (1) angiography remains an important diagnostic tool in the evaluation of patients with penetrating neck trauma; (2) without clinical evidence of vital structure injury, panendoscopy and oesophagography may not be necessary in the routine evaluation of patients with penetrating neck trauma; (3) selective surgical intervention remains an important tool in the evaluation and management of patients with penetrating neck trauma.(AU)

Preliminary evaluation of a new curriculum -incorporation of problem based learning(PBL) into the traditional format

An account of the establishment of Problem Basd Learning(PBL) curriculum at the Eric Williams Medical Science Complex Republic of Trinidad and Tobago provides the forum for a critical analysis of this process and for dialogue with current relevant literature on similar attempts elsewhere. Initial resistance to change and the assessment of the new system is discussed in the light of the fact that this is the first Caribbean territory to use Problem Based Learning as the major instrument to be employed in tertiary level medical education. The analysis uncovers a model of practitioner/researcher which provides a useful conceptual and operational framework for the articulation of the role of those engaged in effecting and studying the management of change.(AU)

Encapsulated thyroid neoplasms (neoplastic thyroid nodules) the Trinidad experience (1981-1985) an histological review - abstract

A review of 447 thyroidectomy specimens showed an incidence of 10.9 percent of encapsulated thyroid neoplasms. The results are summarised as follows: In the follicular specimens, there were 18 African, 1 East Indian, 16 females, 3 males, and the mean age was 57; in the encapsulated follicular, there were 16 African, 9 East Indian, 20 females, 5 males, and the mean age was 40; in the papillary specimen, there were 14 African, 14 East Indian, 22 females, and 6 males, and the mean age was 39; in the medullary specimen, there were 2 African, 0 East Indian, 2 females, 0 males; in the undifferentiated specimen, there was 1 African, 0 East Indian, 1 female, 0 male. Thyroid neoplasms were most commonly seen amongst African women: 56.4 percent of the neoplasms were follicular. Six Hurthle-cell encapsulated neoplasms were seen amongst the tumours; these were all from African women in the sixth decade of life (AU)

Flexible upper gastrointestinal endoscopy the initial experience on a surgical unit - abstract

Fibreoptic upper gastrointestinal endoscopy was started by the Surgical Department of the General Hospital, Port-of-Spain in 1982. Since that time, 142 patients have been examined. All cases were examined by one of a group of five surgeons. There were eighty-six male and fifty-six female patients with an age range 19-92 years. The age group 60-69 years was submitted to endoscopy most frequently (30) followed by the 70-79 years age group (25), and a high incidence of tumour (26) was found which probably reflects the nature of the group studied. They were all referred to a surgical unit. The technique of endoscopy shows an interesting change in that patients early in the series were sedated with diazepan and had their throats anaesthetized with topical xylocaine 'spray'. Later on, however, they were given no systemic medication whatever; the throat was anaesthetized with xylocaine 'spray', and a Pediatric Olympus GIF P3 instrument used for the examination. This technique has greatly faciliated our procedures and there is no recovery time. There was one significant complicatiion, respiratory arrest, in an elderly man who was given Fentanyl. He was resuscitated without difficulty (AU)

The use of the computer in abstracting surgical literature for small-group discussions at the postgraduate level - abstract

The objective of this study was to determine the potential value of a personal computer as an aid to discussion in postgraduate seminars, small group teaching, and patient management. Articles from the journals to which the author personally subscribes -Ann. Roy. Col. Surg., Surg. Gyn. & Obstet., Surgery, The Lancet and the West Ind. Med. J. - have been personally abstracted from 1980 to 1986. The data were recorded on diskettes on an IBM Personal Computer at home. The information can be used on any compatible terminal, by the Author, or any general surgeon, resident, house officer, or undergraduate student. Additional material can be added in a department by any member of staff who could recall it at any time, if suitable equipment is available, The information is entirely personalised and contains only that which the author considers pertinent at the time of input. The use of audio-visual aids in the dissemination of medical information is becoming increasingly important. Management of information using the computer is becoming a requirement in teaching and learning at all levels. The plans for the Faculty of Medical Sciences at Mount Hope entail a liberal use of audio-visual aids. The tecniques that will be displayed in this poster will clearly demonstrate its great advantage (AU)

Open prostatectomy: a study on 132 cases done at two hospitals in Port of Spain

Clinical data on 132 patients who received open prostatectomy during a 9-year period at two institutions in Port-of-Spain, Trinidad, are presented. There were 104 patients from the Port-of-Spain General Hospital and 28 from a private institution. The overall mortality was 38 percent, wound infection contributing to death in most of these cases. The majority of complications which followed prostatectomy performed under the conditions which exist in these two institutions were infective in origin. These can be prevented by performing early prostatectomies when the need for catheterization arises. It is concluded from the results of this study that, despite the conditions which exist at the Port-of-Spain General Hospital, open prostatectomy in old men is a safe procedure. (AU)

Inflammatory bowel disease in the West Indies

Inflammatory bowel disease is generally assumed to be rare among negroes and Indians. Over 10 years 34 cases of ulcerative colitis and 14 cases of Crohn's disease were seen in one medical and one surgical unit in Port-of Spain, Trinidad. Twenty-six patients were Negroes, 18 were Indians, three were of mixed race, and one was Caucasian. In many of these patients the disease was extensive and several of those with Crohn's disease suffered severe complications. The assumption that inflammatory bowel disease is rare among West Indians of African and Indian origin therefore seems to be wrong. (AU)

Psuedo-obstruction and a sprue-like syndrome from stronglyloidiasis

Symptomatic diseases from Strongyloides stercoralis has been recognized for the first time in Trinidad. Five cases are reported, all showing clinical features suggestive of a sprue-like syndrome. Subtotal jejunal villous atrophy was seen in one case and partial villous atrophy in two. Three patients had laparotomies bacause of suspected partial intestinal obstruction. A sprue-like syndrome in certain Caribbean immigrants should arouse a suspicion of S. stercoralis (Summary)

Months' experience with duodenal ulcers in Trinidad - abstract

The surgery of duodenal ulcer has been the commonest major surgery in the author's experience in the Port-of-Spain General Hospital. All such patients operated on in the 18-month period, July 1967 to Dec. 1968 were therefore studied. It was found that overt bleeding was easily the commonest complication of duodenal ulcer and the commonest indcation for surgery. The initial results of therapy by vagotomy and a drainage pocedure appear to be good(AU)

Malignant melanoma in Jamaica

Data collected from thirty-nine cases of melanoma seen at the University Hospital of the West Indies form the basis of this study. The period under review is 1953 to 1965.(AU)

Malignant melanoma in Jamaica

Malignant melanoma comprise 1.3 per cent of all cancers in Jamaica and 13 per cent of all skin cancers. In 62 per cent of cases the lesion develops on the sole of the foot. Of 39 cases seen at the University Hospital of the West Indies between 1953 and 1965, there are only two known five-year survivors. The role of trauma in the aetiology of the disease and its influence on prognosis are discussed. Although melanoma should not be considered a hopeless disease as it has been in the past, local factors tends to influence the outlook in Jamaica adversely (AU)

Retropubic prostatectomy in patients with long standing suprapubic cystostomy

Sixteen patients with gross urinary sepsis and anaemia who had been treated previously by permanent suprapubic drainage that was in adequately managed were subjected to retopubic prostatesectomy. One patient died from a coronary thrombosis. Five patients developed urinary fistulae which healed within a week of catherer drainage. Even where facilities are poor, a condition which obtains in many of the hospitals in this area, a permanent suprapubic cystostomy is never justified as definitive treatment for benign prostatic hypertrophy. The majority of patients can withstand a second stage prostatectomy. The results are rewarding (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)