Clear cell carcinoma of the breast with immunohistochemical evidence of divergent differentiation.

Primary clear cell carcinoma of the breast is a rare tumor. The clear cell morphology of the neoplastic population in these tumors has been ascribed to the presence of intracellular lipid, mucin or glycogen, or to myoepithelial, apocrine, or neuroendocrine differentiation. However, a clear cell neoplasm exhibiting evidence of a range of differentiation has not been previously reported. We describe a case of a glycogen-rich primary clear cell breast carcinoma occurring in a 59-year-old woman that showed positivity for apocrine and neuroendocrine markers, as well as possible myoepithelial differentiation. The tumor was a 4-cm mass composed predominantly of periodic acid-Schiff-positive clear cells arranged in a solid, infiltrative pattern. Immunohistochemical staining of the tumor cells was variably positive for cytokeratin, progesterone receptors, gross cystic disease fluid protein-15, neuron specific enolase, chromogranin, and S-100 protein and negative for estrogen receptors, smooth muscle actin, CD31, and CD34. The patient refused any form of further investigation or treatment, but shows no evidence of recurrence or metastatic disease after 18 months of follow-up.

Patterns of trauma injuries in rural versus urban Jamaica

Trauma admissions to St. Ann's Bay Hospital and the University Hospital of the West Indies (UHWI) in the capital city of Kingston are compared. Trauma accounted for 19 percent and 22 percent of surgical admissions to UHWI and the St. Ann's Bay Hospital, respectively. Sixty-three percent of trauma cases admitted to St. Ann's Bay Hospital and 56 percent to the UHWI were due to unintentional injuries (95 percent CI, -0.05, 0.19). The main cause of unintentional injuries at both hospitals was motor vehicle accidents, accounting for 43 percent and 37 percent at UHWI and St. Ann's Bay Hospital respectively (95 percent CI, -0.04, 0.17). The prevalence of falls was significantly higher in St. Ann's Bay hospital compared with UHWI, 41 percent and 26 percent respectively (95 percent CI, 0.10, 0.21). Intentional injuries accounted for 37 percent of cases in St. Ann's Bay Hospital and 44 percent at UHWI (95 percent CI, -0.20, 0.04). The prevalence of firearm injuries was significantly higher at the UHWI than in St. Ann's Bay Hospital, 55 percent and 18 percent respectively (95 percent CI, -0.15, -0.05). There was no significant difference in age and injury severity scores in the two hospitals but patients remained in hospital significantly longer at UHWI. (AU)

Adenosquamous carcinoma of the stomach with a note of pathogenesis

A case of the rare adenosquamous carcinoma of the stomach is presented. This unusual type of stomach tumor is the first such case to be reported in Jamaica and in the Commonwealth Caribbean. We provide evidence in support of the metaplastic derivation of the squamous component from an existing adenocarcinoma. (AU)

Incarcerated obturator hernia

Incarcerated obturator hernia is rare, only approximately 550 cases appearing in the literature since the first case was reported in 1924. The three cases treated at the University Hospital of the West Indies are presented. They demonstrate many of the clinical features of the condition. Most cases occur in elderly women and they almost always present with symptoms amd signs of small bowel obstruction. Pressure on the obturator nerve by the hernial sac in the obturator nerve by the hernial canal results in a positive Howship-Romberg sign in about 50 percent of the patients. If the diagnosis is suspected pre-operatively, confirmation may be obtained by computerized tomography. This, however, seems unnecessary as prompt exploration is advisable due to the high incidence of gangrene of the bowel. At surgery, attempts at reduction frequently result in damage to the small bowel, and resection is often necessary due to injury or gangrene. Closure of the entrance to the canal with interrupted non-absorbable sutures is adequate, and prosthetic material is necessary only for very large defects. The high mortality rate reported is probably due to the age and poor general condition of affected patients (AU)

A simple technique for closed suction drainage

Closed suction drainage if the most effective system of drainage for clean wounds, especially those in which skinflaps are made. The availability of such systems in developing countries is frequently uncertain due to financial constraints. To overcome this problem, we have devised a simple suction drainage system utilising inexpensive and readily available materials. The system consists of a 50 ml plastic disposal syringe attached to a length of sterile oesophageal tubing. The tubing is placed under the skinflaps in the usual fashion and the skin closed. Suction is applied to the tubing by aspirating the syringe, the plunger of the syringe being maintained in the aspirating position by inserting a safety pin throught the plastic shaft. To empty the syringe the tubing is clamped and the syringe detached and emptied. The syringe is then re-attached and suction applied before the clamp is released. The system has been successfully employed in a number of cases, including mastectomy, thyroidectomy, incisional hernia repair and excision of a large subcutaneous lipoma. The simplicity of the system also allows it to be used in same day care surgery.