Feasibility of an electrostimulation system treatment for wound healing: a case series of patients with chronic ulcers in Barbados.

Major advances have been made in the development of new therapies for chronic wounds. Fenzian™, an electrostimulation system (ES), has been clinically used for a variety of conditions. The ES was recently tested in the Barbadian population for tolerability and acceptability by asthma patients, with encouraging results. Barbados has an estimated 170 people with diabetes having some form of lower-extremity amputation annually. Here, we describe a case series of 21 chronic ulcer patients with diabetes recruited as inpatients (n = 10) and outpatients (n = 11) in a pilot study to evaluate the feasibility and acceptability of ES in the Barbadian population. Results showed statistically significant improvement among those in the inpatient- versus outpatient-recruited group for wound perimeter (P = 0·04), wound surface area (P = 0·03) and wound volume (P = 0·08). We also demonstrate that the improvement continued after cessation of ES treatment. Participants reported increased levels of pain at the end of treatment, and there was no statistically significant change in the reported quality of life. Our results showed greater improvements in reduction of ulcer size for participants from the inpatient- versus outpatient-recruited group.

Absence of the appendix discovered during childhood.

Absence of the appendix is rare. Isolated cases are usually discovered in adult patients or cadavers. We report the case of a 14 year old boy who was found to have no appendix on laparotomy for assumed acute appendicitis and use this opportunity to highlight the growing surgical uses of this vestigial structure.

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)

Appendicitis complicating pregnancy

Abdominal pain is a common symptom in pregnancy. Its etiology is diverse and diagnosis often poses a problem. Inflammatory disorders of extra-uterine origin such as appendicitis should always be considered as a possible cause. Three cases of appendicitis complicating pregnancy managed at the Queen Elizabeth Hospital, Barbados during the year 1993 are documented. Two presented in the antenatal period and the third postpartum. The clinical manifestations and the difficulties encountered in diagnosis are emphasised. (AU)

Breast cancer screening

Breast cancer is the most common form of cancer in women in developed countries and is second only to carcinoma of the cervix in developing countries. Breast cancer is an insidious disease and may be present and develop gradually over years with no signs or symptoms. It is uncommon before the age of 35. The incidence increases rapidly between age 35-50 in high incidence areas and continues to climb although not as steeply as before. The natural history of the disease is poorly understood. When we speak of screening we are referring to an exercise in which apparently healthy individuals in the population are tested and classified according to their test results with those having abnormal tests being further appropriately investigated. Some of the methods used in breast screening include: breast self-examination, clinical breast examination, fine needle biopsy and mammography

The problem of limb amputations in Barbados - abstract

There were 2,506 admissions to the general surgical wards of the Queen Elizabeth Hospital during the period April, 1978 to March, 1979. There were 358 admissions (14 percent) for "foot" problems of whom 131 were known diabetics. 136 major amputations were done during this time. This paper reviews the circumstances surrounding this problem of limb wastage. Of 358 patients with "foot" problems, 212 (60 percent) had operative procedures for the treatment of gangrene, ulceration and infection. About a third of the patients operated on had more than one operative procedure, usually in an attempt to save the limb. 136 limbs were lost. The average length of stay was extended by efforts that were made to save limbs from major amputations and was 55 days compared to 8 days for the hospital as a whole. 75 percent of the patients were over 60 years of age and 82 of 212 patients operated on were known diabetics. In a sub-sample of 32 diabetics, three quarters of the patients had had avoidable injuries which precipitated their admission to hospital. These were mainly associated with minor injury to the feet, yet only two patients were aware of the potential seriousness of these minor injuries. Minor trauma and sepsis in a diabetic must be treated as an emergency with adequate debridement and full protection. Observation must be particularly close in patients with loss of pain sensation as a result of a neuropathy. There is need for a limb manufacture and fitting service locally. In 1979 of 25 requests made for artificial limbs, only 10 were fitted, all of which had to be imported (AU)