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1.
J Forensic Leg Med ; 17(5): 269-71, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20569954

RESUMO

Body packing is one method of smuggling cannabis across international borders. The practice is prevalent in Jamaica. There has been one reported death from this practice in medical literature. We report a second fatal case of cannabis body packing, reinforcing the dangerous nature of this practice.


Assuntos
Cannabis , Colo Sigmoide/lesões , Crime , Embalagem de Medicamentos , Perfuração Intestinal/etiologia , Viagem , Abscesso Abdominal/etiologia , Abscesso Abdominal/patologia , Abscesso Abdominal/cirurgia , Colectomia , Colo Sigmoide/patologia , Colo Sigmoide/cirurgia , Evolução Fatal , Feminino , Humanos , Íleo/lesões , Íleo/patologia , Íleo/cirurgia , Perfuração Intestinal/patologia , Pessoa de Meia-Idade , Sepse/etiologia , Bexiga Urinária/lesões , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia
2.
BMC Surg ; 10: 6, 2010 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-20152019

RESUMO

BACKGROUND: During a previous study to define and compare incidence risks of postoperative nausea and vomiting (PONV) for elective laparoscopic and open cholecystectomy at two hospitals in Jamaica, secondary analysis comparing PONV risk in elective open cholecystectomy to that after emergency open cholecystectomy suggested that it was markedly reduced in the latter group. The decision was made to collect data on an adequate sample of emergency open cholecystectomy cases and further explore this unexpected finding in a separate study. METHODS: Data were collected for 91 emergency open cholecystomy cases identified at the two participating hospitals from May 2007 retrograde, as was done for the 175 elective open cholecystectomy cases (from the aforementioned study) with which the emergency cases were to be compared. Variables selected for extraction and statistical analysis included all those known, suspected and plausibly associated with the risk of PONV and with urgency of surgery. RESULTS: Emergency open cholecystectomy was associated with a markedly reduced incidence risk of PONV compared to elective open cholecystectomy (6.6% versus 28.6%, P < 0.001). The suppressive effect of emergency increased after adjustment for confounders in a multivariable logistic regression model (odds ratio 0.103, P < 0.001). This finding also identifies, by extrapolation, an association between reduced risk of PONV and preoperative nausea and vomiting, which occurred in 80.2% of emergency cases in the 72 hour period preceding surgery. CONCLUSIONS: The incidence risk of postoperative nausea and vomiting is markedly decreased after emergency open cholecystectomy compared to elective open cholecystectomy. The study, by extrapolation, also identifies a paradoxical association between pre-operative nausea and vomiting, observed in 80.2% of emergency cases, and suppression of PONV. This association, if confirmed in prospective cohort studies, may have implications for PONV prophylaxis if it can be exploited at a sub-clinical level.


Assuntos
Colecistectomia/efeitos adversos , Colecistectomia/métodos , Náusea e Vômito Pós-Operatórios/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
West Indian med. j ; 50(3): 239-42, Sept. 2001.
Artigo em Inglês | MedCarib | ID: med-275

RESUMO

A case of compartment syndrome of the thigh following a gunshot injury that resulted in significant morbidity is presented. Early diagnosis of this uncommon condition requires a high index of suspicion in order to reduce morbidity and mortality. Timely diagnosis, emergency three-compartment decompression, prophylaxis against reperfusion syndrome and aggressive rehabilitation are necessary for a favourable outcome. (AU)


Assuntos
Adulto , Relatos de Casos , Humanos , Masculino , Síndromes Compartimentais/etiologia , Quadril/lesões , Ferimentos por Arma de Fogo/complicações , Jamaica , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/cirurgia
4.
West Indian med. j ; 50(2): 144-7, Jun. 2001. tab
Artigo em Inglês | MedCarib | ID: med-343

RESUMO

Lipomas of the colon are uncommon but cause diagnostic difficulty when they are symptomatic. The clinical and pathological features of 17 cases of colonic lipomas diagnosed at the University Hospital of the West Indies between 1970 and 1999 are reported. Ten cases were symptomatic, two of these being diagnosed with adult intussusception. Six patients had incidental lipomas in bowel resected for other patholgoy while one lipomas was diagnosed an sigmoidoscopy. Increased awareness of these lesions will enhanced pre-operative diagnostic accuracy.(Au)


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Lipoma/epidemiologia , Neoplasias do Colo/epidemiologia , Jamaica/epidemiologia , Neoplasias do Colo/diagnóstico , Lipoma/diagnóstico
5.
Trop Doct ; 30(4): 214-6, Oct. 2000. tab
Artigo em Inglês | MedCarib | ID: med-129

RESUMO

Twenty-seven children aged 18 years and under with homozygous sickle-cell disease had open cholecystectomy for symptomatic gallstones over the 12 year period 1985-1997. Emergency procedures (done during period of acute exacerbation of symptoms) were performed on 16 patients. Four with haemoglobin levels greater than 1g/dl below their steady state received a simple blood transfusion preoperatively designed to raise haemoglobin levels to 10g/dl. All had acute or acute on chronic cholecystitis based on histological examination of gallbladder specimens. Twelve had common bile duct stones. In two patients calculi were missed intraoperatively but these subsequently passed into the duodenum after a period saline irrigation via an in-situ t-tube. Six developed the acute chest syndrome (aetiology not determined) and this progressed to multi system failure and death in one. This high level of postoperative mobility and mortality may in part be due to the high proportion of emergency procedures. (AU)


Assuntos
Criança , Feminino , Humanos , Masculino , Adolescente , Anemia Falciforme/complicações , Bem-Estar da Criança/estatística & dados numéricos , Colecistostomia/estatística & dados numéricos , Colelitíase/epidemiologia , Colelitíase/cirurgia , Colecistostomia/mortalidade , Colelitíase/etiologia , Tratamento de Emergência , Jamaica/epidemiologia , Prevalência
6.
West Indian med. j ; 49(3): 242-4, Sept. 2000. graf
Artigo em Inglês | LILACS | ID: lil-291983

RESUMO

A case of chronic relapsing pancreatitis presenting in an 8-year old African Jamaican girl is outlined. Aggressive supportive management failed to control pain and vomitting. The Puestow Procedure effectively aborted these symptoms. The use of the Puestow procedure should not be inordinately delayed in chronic relapsing pancreatitis if symptoms persist, since it may not only control pain but also halt declining pancreatic function.


Assuntos
Criança , Feminino , Humanos , Drenagem , Ductos Pancreáticos , Pancreatite , Drenagem , Jamaica
7.
West Indian med. j ; 49(3): 242-4, Sept. 2000. gra
Artigo em Inglês | MedCarib | ID: med-668

RESUMO

A case of chronic relapsing pancreatitis presenting in an 8-year old African Jamaican girl is outlined. Aggressive supportive management failed to control pain and vomitting. The Puestow Procedure effectively aborted these symptoms. The use of the Puestow procedure should not be inordinately delayed in chronic relapsing pancreatitis if symptoms persist, since it may not only control pain but also halt declining pancreatic function.(Au)


Assuntos
Criança , Feminino , Humanos , Relatos de Casos , Pancreatite , Ductos Pancreáticos , Drenagem , Jamaica , Drenagem
8.
West Indian med. j ; 49(Suppl. 2): 55, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-912

RESUMO

OBJECTIVE: This study documents the morbidity pattern of diseases in patients presenting to the Accident and Emergency (A&E) Unit at the University Hospital of the West Indies in Jamaica. DESIGN and METHODS: Data were retrieved from a log book kept by the nursing staff in the A&E Unit at the UHWI. This SPSS software package was used to select 100 random days in 1997. All cases treated in the A&E Unit on those days were included in the study. Data collected included demographic data, discharge diagnosis and disposal. Diagnosis were coded and classified using the International Classification of Diseases - 9th edition coding system. RESULTS: In 1997, 16,798 patients were treated in the A&E Unit during the 100 random days selected, 4611 of these were seen. Twelve cases were excluded, as the diagnoses were unknown. Some patient had more than one diagnosis and therefore, 4762 diagnoses were made in 4599 patients. The mean age was 34ñ 24 (SD) years. The male to female ratio was 1.8:1. Injuries and poisoning accounted for 31 per cent of cases. Respiratory diseases were the next most prevalent (16.2 percent). Cardiovascular and digestive diseases accounted for 5.8 and 10.5 per cent of cases, respectively. Infectious diseases accounted for only 1.75 per cent of cases; 71.7 per cent of patients were discharged home, 23.5 per cent admitted and 4.2 per cent transferred to another institution. The mortality rate was 0.6 per cent. CONCLUSIONS: The pattern of diseases seen in this study demonstrates epidemiologic transition where injuries, cardiovascular and other chronic diseases are evolving as the most prevalent conditions seen. This is now seen frequently in the Caribbean and other developing countries. (Au)


Assuntos
Feminino , Humanos , Masculino , Inquéritos de Morbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Coleta de Dados , Fatores Epidemiológicos , Jamaica , Doença Crônica/epidemiologia , Doenças Cardiovasculares/epidemiologia , Ferimentos e Lesões/epidemiologia
9.
West Indian med. j ; 49(Supp 2): 36, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-954

RESUMO

OBJECTIVE: This study was done to determine the aetiology of penetrating torso injuries in patients presenting at the University Hospital of the West Indies (UHWI) as well as to document the organs frequently injured and to assess the outcome of these cases. DESIGN AND METHODS: Data were derived from the UHWI trauma registry. All patients presenting to the UHWI with penetrating torso injuries between January 1, 1998 and June 30, 1999 were studied. Biographic data, cause of injury, organs injured and procedures used in treatment were recorded. TRISS methodology was used to identify unexpected deaths. RESULTS: 1899 (42 percent) of the 4,496 admissions to the surgical services of the UHWI were due to trauma. Two hundred and twenty-nine (229) of these had torso injuries and 159 (8 percent) were due to penetrating injuries. Assaults accounted for 98 percent of cases. The male to female ratio was 7.4:1 and the mean age was 28 +or- 10 (SD) years. There were 92 (59 percent) stab wounds and 63 (41 percent) firearm injuries. Mean hospital stay was 8 +or- 15 (SD) days. Mortality rate was 10 percent. Small bowel (17), colon (15) and liver (15) were the abdominal organs most frequently injured. Pneumothorax or haemothorax was detected in 107 patients. All except 20 patients had a major surgical procedure done. There were seven non-therapeutic thoracotomies and 17 non-therapeutic laparotomies. Greater than 50 percent deaths were assessed as preventable. CONCLUSIONS: The wider use of imaging procedures in treatment protocols should reduce the number of non-therapeutic procedures. The preventable death rate may be decreased through training in ATLS protocols and improved equipment maintenance.(Au)


Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Masculino , Ferimentos Penetrantes/etiologia , Diagnóstico por Imagem , Coleta de Dados , Traumatismos Abdominais , Traumatismos Torácicos , Pneumotórax/cirurgia , Jamaica
10.
West Indian med. j ; 48(4): 200-2, Dec. 1999. tab, gra
Artigo em Inglês | MedCarib | ID: med-1572

RESUMO

Sera from 111 patients with trauma injuries, who presented to the Accident and Emergency Unit (A&E), University Hospital of the West Indies, during a 3-month period, were screened for blood alcohol. Urine specimens were analysed for metabolites of cannabis and cocaine. Sixty-two percent (62 percent) of patients were positive for at least one substance and 20 percent for two or more. Positivity rates were as follows: cannabis (46 percent), alcohol (32 percent) with 71 percent of these having blood alcohol levels (BAC) greater than 80 mg per decilitre; cocaine (6 percent). Substance usage was most prevalent in the third decade of life. The patients who yielded a positive result were significantly younger than those who were negative. There was no significant difference in age or substance usage between the victims of interpersonal violence or road traffic accidents. In the group designated "other accidents", patients were significantly older and had a lower incidence of substance usage that the other two groups. Cannabis was the most prevalent substance in all groups. Fifty percent (50 percent) and fifty-five percent (55 percent) of victims of road accidents and interpersonal violence, respectively, were positive for cannabis compared with 43 percent and 27 percent for alcohol, respectively. There was no significant difference in Hospital Stay or Injury Severity Score between substance users and non-users.(AU)


Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Humanos , Masculino , Adolescente , Alcoolismo/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Ferimentos e Lesões/epidemiologia , Abuso de Maconha/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Índias Ocidentais/epidemiologia , Abuso de Maconha/complicações
11.
West Indian med. j ; 48(3): 141-2, Sept. 1999. tab, gra
Artigo em Inglês | MedCarib | ID: med-1496

RESUMO

Trauma accounted for 37 percent of 22,311 patients seen in the Accident and Emergency Unit (A&E) at the University Hospital of the West Indies (UHWI) during 1996. Thirty-nine percent of injuries were intentional and 18 percent were due to motor vehicle accidents. Knives, machetes and rocks accounted for 75 percent of the injuries compared with 5 percent for gunshot wounds. Passengers were injured in about 40 percent of motor vehicle accidents and pedestrians in 19 percent. The admission rate was 16 percent and the orthopaedic clinic received 75 percent of the patients referred to specialist clinics. Victims of motor vehicle accidents made up a greater proportion of admissions (24 percent) than those of unintentional violence (13 percent). The average cost of caring for each patient in the A&E Unit was US$70 resulting in an annual cost of US$578,000.(AU)


Assuntos
Adulto , Criança , Pré-Escolar , Lactente , Pessoa de Meia-Idade , Idoso , Humanos , Adolescente , Ferimentos e Lesões/etiologia , Ferimentos por Arma de Fogo , Acidentes de Trânsito/tendências , Jamaica , Violência , Acidentes , Acidentes de Trânsito , Queimaduras , Custos de Cuidados de Saúde , Custos e Análise de Custo
13.
West Indian med. j ; 47(suppl. 3): 43-4, July 1998.
Artigo em Inglês | MedCarib | ID: med-1685

RESUMO

Breast cancer is now the commonest malignancy among females in Jamaica. In 1985 a Breast Cancer clinic was established at the University Hospital of the West Indies (UHWI) and, because young age has been suggested to be an adverse prognostic factor, data collected during the first five years were analysed to establish the pattern of this disease in young women. Thirty of the 227 female patients seen at the clinic during this period were under age 40. Information was insufficient in one case and the remaining 29 formed the study group. Only three patients were less than 30 years of age, 15 being aged 35 to 39 years. Family history was negative in 16 of 24 cases. In 28 patients presentation was related to the finding of a mass. Treatment was by surgery with or without adjunctive therapy. Eight patients were assessed as stage I, eleven were stage II and nine were stage III. Of the 20 patients for less than five years, there were three deaths and eight were distant metastases. Two of the other nine patients had distant metastases. There may be several reasons including difficulty in accessing health care, attitudes to health care that delay diagnosis, and race, why in so many of the study group the presenting disease was advanced, but no information was available to suggest what role these factors might have played in our patients.(AU)


Assuntos
Adulto , Feminino , Humanos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Jamaica
14.
West Indian med. j ; 45(3): 85-8, Sept. 1996.
Artigo em Inglês | MedCarib | ID: med-3501

RESUMO

This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.(AU)


Assuntos
Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/economia , Dor Pós-Operatória , Estudo de Avaliação
15.
West Indian med. j ; 45(3): 85-8, Sept. 1996.
Artigo em Inglês | LILACS | ID: lil-180085

RESUMO

This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.


Assuntos
Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/economia , Estudo de Avaliação , Dor Pós-Operatória
16.
West Indian med. j ; 44(4): 146-7, Dec. 1995.
Artigo em Inglês | MedCarib | ID: med-4789

RESUMO

A case of obstructive jaundice secondary to a neurofibroma in the common hepatic duct is presented. The histological appearance was that of a plexiform neurofibroma. The clinicopathological features are discussed (AU)


Assuntos
Adulto , Relatos de Casos , Feminino , Humanos , Neurofibroma Plexiforme/patologia , Colestase/etiologia , Neoplasias dos Ductos Biliares/patologia , Neurofibroma Plexiforme/cirurgia , Ducto Hepático Comum/metabolismo
17.
West Indian med. j ; 44(4): 146-7, Dec. 1995.
Artigo em Inglês | LILACS | ID: lil-165468

RESUMO

A case of obstructive jaundice secondary to a neurofibroma in the common hepatic duct is presented. The histological appearance was that of a plexiform neurofibroma. The clinicopathological features are discussed


Assuntos
Adulto , Feminino , Humanos , Neoplasias dos Ductos Biliares/patologia , Colestase/etiologia , Neurofibroma Plexiforme/patologia , Ducto Hepático Comum/metabolismo , Neurofibroma Plexiforme/cirurgia
18.
West Indian med. j ; 44(Suppl. 2): 23, Apr. 1995.
Artigo em Inglês | MedCarib | ID: med-5789

RESUMO

TRISS methodology is a statistical method for detecting unexpected outcome in trauma patients. Unexpected deaths can then be audited to determine the Preventable Trauma Death Rate (PDT), which is a good indicator of the quality of trauma care. This method was utilized to assess trauma care at the University Hospital of the West Indies (UHWI) and to identify areas of treatment failures. All trauma deaths at the UHWI during the calender year 1993 were reviewed. The Probability of Survival (PS) was calculated for each patient, using the Revised Trauma Score and the Injury Severity Score. Unexpected deaths (patients with PS > 0.5) were audited to detect inadequate trauma care. In 40 patients there were 15 unexpected deaths of which 7 were deemed potentially salvageable. Six of these were related to either inadequate resuscitation or delayed surgical intervention. The other was due to surgical inexperience. This represents a PTD rate of 22.5 percent which is similar to that in North America more than a decade ago. Most deaths occurred within the first 12 hours of hospitalization with another peak at approximately 9 days. Improvement in trauma care at UHWI can be achieved by the introduction of relatively cheap countermeasures rather than by acquiring expensive medical equipment. Continuing Medical Education programmes like the Advanced Trauma Life Support course should be introduced and may result in improvement in trauma care similar to that of developed countries (AU)


Assuntos
Humanos , Masculino , Feminino , Ferimentos e Lesões/mortalidade , Escala de Gravidade do Ferimento , Jamaica
20.
West Indian med. j ; 43(3): 107-9, Sept. 1994.
Artigo em Inglês | MedCarib | ID: med-7753

RESUMO

One case of atherosclerotic gluteal artery aneyrysm (GAA) is presented. The diagnosis was made pre-operatively, and treatment involved ligation and division of the internal iliac artery only. This therapeutic option is discussed as the perferred one compared to the conventional two-step procedure (AU)


Assuntos
Humanos , Idoso , Feminino , Nádegas/irrigação sanguínea , Aneurisma/cirurgia , Aneurisma/diagnóstico , Aneurisma/etiologia , Ultrassom
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