Spontaneous rupture of the spleen

A 10 year old boy presented to the surgical serviceof the Queen Elizabeth Hospital with spontaneous rupture of the spleen and was later discovered to have chronic myeloid leukaemia. He has been in haematological remission for five years following splenectomy and oc-interferon therapy.(AU)

Renal transplantation from living related donors in Barbados

The results of 10 living donor (LRD) renal transplants performed in Barbados during the period 1987 to 1997 are reported. The donors were four mothers, three fathers, two brothers and an uncle. The six female and four male recipients were 14 to 36 years of age. Four recipients displayed delayed graft function (DFG), ie, failure to produce more than 1.0 L of urine in the first 24 hours and/or failure to reduce plasma creatinine by more than 50 percent in the first 48 post-operative hours. Two of these grafts were lost due to thrombosis of the allograft anastomisis; one patient successfully resumed haemodialysis therapy following transplant nephrectomy but the other died from the respiratory distress syndrome three days after transplantation. Of the remaining two patients with DGF, one showed impaired function at one year and subsequently lost the allograft at ten years post-transplantation from chronic rejection, the other has "normal" renal function five year post-transplantation. One other patient died in the early post-operative period, from a cerebral haemorrhage due to uncontrolled hypertension. Five of the allografts were functioning five years after transplantation (mean plasma creatinine = 169.2 umols/l); one has a plasma creatinine of 112 umols/l at one year and another has a plasma creatinine of 300 umols/l eight months after transplantation. This experience shows that the infrastructure to support LRD renal transplants is established in Barbados and can be used to supplement renal replacement initiatives in Barbados and in neighbouring Eastern Caribbean states.(AU)

Intussusception in Barbados: a six-year study - abstract

Intussusception remains one of the most common causes of the acute abdomen in childhood. Early diagnosis determines the course of the treatment and the morbidity or mortality of the condition. To date, there have been no studies done on this condition in Barbados. To evaluate the extent of this condition in Barbados, the charts of patients admitted to the Queen Elizabeth Hospital, Barbados, between January, 1987 and December, 1992 were reviewed. Of the 38 patients admitted to the institution with intussusception in the study period, 28 (74 percent) were children, all aged two years and below. Among children, male patients predominated over female by a ratio of 1.8:1. The majority of the children presented with the classical clinical picture of intussusception, namely: colic (100 percent), vomiting (93 percent), mucoid bloody stool (70 percent) and a palpable mass (56 percent). Of the 21 children seen within 24 hours of the onset of the symptoms, 7 out of 18 (39 percent) had a successful hydrostatic reduction by barium enema. Most children subjected to laparotomy required simple reduction only (90 percent). In this series of patients, 31 (82 percent) underwent laparotomy; all the 10 adults in this series required laparotomy and resection of bowel. A pathological lead point was found in 90 percent of the adult patients. Two children had recurrence of intussusception after operative reduction, within 9 months of the initial presentation. There was no mortality in this series (AU)