Hospice home care centre - abstract

The Hospice concept provides great comfort to the terminally ill. However, the original in-patient type of Hospice is expensive; hence it is not possible to provide its benefits to the very poor in the Third World. In recent times, the move has been to have patients remain in the comfort of family surroundings. The Hospice Home Care Centre was planned to investigate what form of care would be most practical and appropriate to the needs of very poor patients in the area around Eastern Kingston. Since April 1987, 179 patients have been referred to the Centre. Among female patients (n=137), cervical (44 percent) and breast (29 percent) cancers predominate, while in male patients (n=42), lung (24 percent), prostate (11 percent) and stomach (11 percent) cancers are more common. The length of time for which patients are looked after averages just over 2« months (AU)

Observations on idiopathic scoliosis aetiology and natural history in Jamaica - abstract

In 1953, the Orthopaedic Department at the University of the West Indies opened. Over the next five years, careful records were kept of the diagnosis of every patient seen in the Clinics. Amongst the findings was the observation that the idiopathic form of scoliosis appeared to be uncommon. There was a strong impression that the incidence of scoliosis was altering. From the second half of 1956, records of every patient with scoliosis from whatever cause have been kept. Only cases of severity great enough to attend an Orthopaedic Clinic and found to have a curve measuring over 10 degrees have been included. These records show that scoliosis has been an unusual condition from at least 1920 when our earliest case was reported as having developed. The condition continued to be unusal up to 1963. Then the whole position began to change. The records of the dates of presentation of new cases showed that there was a sudden increase after 1960 so that these patients became a major clinical problem. The increase in frequency rose rapidly till 1982. Then began a downturn in the number of cases which have continued. This has been in spite of a continuing annual population increase of 1.5 per cent and a steady 50 per cent of the population remaining under 15 years of age. Over the thirty-two years of this study, the general pattern of idiopathic scoliosis seen elsewhere has been found. In addition to the idiopathic group, there were almost 10 per cent due to some obvious cause. The infantile and juvenile types were seen only seldom. It was found that the idiopathic scoliosis patient was consistently above the average height for her age group and that the normal growth spurt appeared earlier in the idiopathic group than in other children. Thus, in Jamaica, there has been almost an epidemic of idiopathic scoliosis which started around 1963 and began to fall off after 1982. The increase in both the heights of these patients and their metacarpal indices suggests that something may have stimulated growth (AU)

The Natural history of idiopathic scoliosis in Jamaica - abstract

This study analyses 877 cases, 691 female and 186 male patients. Eighty-one of these cases were of the secondary form of scoliosis and the diagnosis of these is presented. The age of onset of the 796 idoipathic cases showed only 0.3 percent of the infantile type and 2.5 percent of the juvenile type. Both of these figures are less than in most other reported series. The study was begun in 1956 and records every case seen at the University's Orthopaedic Clinic which deals with scoliosis in Jamaica and several of the other Caribbean islands. The last two years, after 1966, have been excluded because many patients had had the condition for several years before they presented to hospital which would falsify any observations concerning the year of onset. The types of curve and their frequency are presented. Special attention was paid to the year of onset of the idiopathic variety which showed a remarkable increase after 1968. This observation has led to suggestions concerning the aetiology of idiopathic scoliosis which have been correlated with:- a). The idiopathic type was found to be particularly common in patients from the three higher income groups in the community; b). The average heights of both male and female idiopathic scoliosis patients are over 2 cm greater than for normal children of similar age; c). The metacarpal indices similarly are greater than those found in normal children of similar age; d). The growth spurt starts earlier in patients with idiopathic scoliosis. These findings, together with the increased frequency up to 1983 and the subsequent decline in frequency which is continuing, suggest that social factors are of importance in the aetiology of the condition (AU)

Idiopathic scoliosis in a Jamaican population - abstract

This two-year retrospective study analyses the results of operative treatment of patients with idiopathic scoliosis, using the Harrington Instrumentation. The series consists of 63 consecutive cases, 50 boys and 13 girls. The average age at presentation was 16 years and the curves varied from 42§ to 86§. Most of the curves affected the dorso-lumbar vertebrae and the majority were convex to the right; 10 percent of the cases showed clinical evidence of neurofibromatosis and 15 percent had a marfanoid appearance with no systemic evidence of Marfan's syndrome. Seven cases were treated pre-operatively with a Risser's turnbuckle cast. Operative treatment consisted of correction of the major cure with a Harrington distraction rod and posterior fusion. On-lay bone graft was done using bone obtained from the spinous processes of the vertebrae. No additional bone was used. Post-operatively, all patients were nursed free on a Stryker frame for fourteen days. After this, an underarm plater jacket was applied. This was worn for three months. Patients were discharged after the jacket was applied and were allowed to attend school. Only restricted activities were allowed then. Full activities were allowed after the jacket was removed. The average correction obtained was 33 percent and the mean loss of correction after one year was 4§. The complications were varied and consisted of minor wound sepsis, temporary neurological deficit in two cases, intestinal obstruction in one case and pseudo-arthrosis in one cases. The scoliosis programme in Jamaica has contributed significantly to the improvement in the quality of life of affected patients. The emphasis now is on early detection and institution of early conservative management (AU)

Rigid internal fixation of intra-articular fractures by tension band wiring - abstract

Based on the principle that "The implant absorbs the tension and bone the compression" of the A. O. group, a number of suitable fractures have been treated by Tension Band Wiring. Using this technique, we have treated 19 fractures of the olecranon, 14 of the patella and 23 of the medial malleolus, at the University Hospital of the West Indies and at Hoberton Hospital, St. John's, Antigua. In spite of intensive physiotherapy, starting the day following surgery, 905 of the patients with fractures of the olecranon and medial malleolus showed evidence of clinical and radiological union at the end of six weeks, with almost full range movements at elbow and ankle joints. The average period of clinical and radiological union in fractures of the patella was 76 days; 95 percent of the patients in the patella series progressed to full weight bearing at the end of 12 weeks with a full range of motion at the knee. Complications which developed (average follow-up of 7.4 months) were 7 percent superficial infections and in 16 percent pain continued at the fracture site until the implant was removed. It has been found that if the patient, implant fracture and technique were properly matched, the results of this short surgical procedure were excellent. Painless stability is afforded so that early active joint movement can be obtained throughout the phase of bone healing. The patient goes back to work earlier, with less complications, compared with other methods of treatment (AU)