RESUMO
The first double-blind-placebo field trial, using the drug ivermectin to control M. ozzardi microfilariae, was conducted in Blanchisseuse, North Trinidad. A preliminary trial indicated that there were no major constraints in administering the drug ivermectin within the community. In 16 patients before treatment, the microfilariae density ranged from 1 to 5,679 mf/ml, and the geometric mean was 697 mf/ml compared to 4 to 2,042 mf/ml and 362 mf/ml in the 14 patients given the placebo. Following treatment 87.5 percent (14/16) experienced side effects including fever and arthralgia (12 cases), myalgia (3 cases), headaches (11 cases) and chills (8 cases). All symptoms disappeared after 24 hours. Twenty-four hours after the ivermectin treatment the M. ozzardi microfilariae densities significantly (p < 0.001) declined to zero in 11 out of 16 cases (68.8 percent) while in 5 cases densities declined by > 95 percent. One week post-treatment there were no microfilariae observed in 93.8 percent (15/16) of cases, with one patient not attending the clinic. Blood samples collected 1 and 5 months after ivermectin treatment revealed M. ozzardi microfilariae in 3 patients. These 3 patients were re-treated with 6 mg of ivermectin, but two patients demonstrated persistent parasitaemias in subsequent blood samples. Within the placebo group, fluctuating levels of microfilariae were observed (AU)
Assuntos
Humanos , Ivermectina/uso terapêutico , Mansonelose/tratamento farmacológico , Trinidad e Tobago , MicrofiláriasRESUMO
We describe a female diabetic patient who presented with features suggestive of hepatobiliary disease and who exhibited clinical signs of fulminant hepatic failure. Identification and drainage of a right perinephric abscess resulted in prompt resolution of both the physical signs and biochemical indices of liver disease. Infection remote from the hepatobiliary tree can mimic fulminant hepatic failure, and recognition of this unusual presentation of infection is important if dangerous delay in diagnosis and treatment is to avioded. (AU)
Assuntos
Humanos , Adulto , Feminino , Abscesso/microbiologia , Nefropatias/microbiologia , Encefalopatia Hepática/etiologia , Icterícia/etiologia , Encefalopatia Hepática/tratamento farmacológico , Diagnóstico Diferencial , Diabetes Mellitus/complicaçõesRESUMO
The prevalence of diverticular disease of the colon in Trinidad is higher than in the other developing countries. A 46-month review yielded 52 cases with complications of the entity. Haemorrhage was the most common complication (65 percent) but required surgery in only 11.7 percent of cases. Acute diverticulitis and pericolic abscess accounted for 23 percent of the total and required surgery in 58 percent (7/12). There were 4 cases of colovesical fistula and 2 with chronic abdominal pain. The sigmoid colon was the most often affected segment of the large bowel. In the only case where bleeding was localized pre-operatively, the site was in the hepatic flexure. Sigmoid colectomy was the most frequently performed procedure (59 percent) with wound infection complicating 26 percent of the cases. Only one patient managed conservatively had recurring symptoms (2.8 percent). Conservative therapy appears to be the management of choice of this emerging disease entity (AU)
Assuntos
Humanos , Doença Diverticular do Colo/complicações , Trinidad e Tobago/epidemiologiaRESUMO
Familial occurrence of colorectal carcinoma in the absense of polyposis is an uncommon but well-documented entity. Although colonic carcinoma is relatively uncommon in the developing world, 3 families with clustering of this tumour have been identified in Trinidad. In this first reporat of familial colonic cancer from the West Indies, the families were (one each) of African, Chinese and East Indian origin. There was slight male predominance (M:F = 1.2:1). Early onset of the disease and poor prognosis were uniform features, with average age at death being 45.4 years. The right colonic involvement synchronously or metachronously occurred in the remainder. An aggressive policy of surveillance in affected members and screening in asymptomatic relatives should favourably alter the prognosis in such stricken families (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Neoplasias do Colo/epidemiologia , Trinidad e TobagoRESUMO
In a prospective study of 203 patients with lwoer limb ulcers, there were 38 positive wound cultures. The total study group consisted of 124 diabetics and 79 non-diabetics. The vast majority of patients who were culture positive were diabetic (35/41, 85 percent) and only 3.7 percent (3/79) ofnon-diabetic ulcers were culture positive. In diabetics, polybacterial infections were most common, affecting over 90 percent of the cases. The most common pathogens were Pseudomonas (12), Klebsiella (13) and Proteus (10). Gram-positive organisms were present in 7 cases due to Staphylococci, and to Streptococci in 6 cases. The low culture rate was probably related to failure to culture anaerobic organisms and to prior antibiotic therapy. A follow-up study to include anaerobic cultures is planned, to better elucidate the bacteriology of this common surgical problem (AU)
Assuntos
Humanos , Pé Diabético/microbiologia , Trinidad e TobagoRESUMO
Because of increasing cost in health care, it was thought valuable to examine critically our current pratice of surgery with specific reference to measures that could result in cost reduction, while maintaining quality surgical care. Our study at Port-of-Spain General Hospital revealed that routine admission of minor head injuries results in necessary hospitalization and X-rays in over 1,000 patients per year. Review of routine chest X-ray and ECG in 1063 consecutive pre-operative cases showed that 95 percent of these indicated. Group and cross-matching of blood, though performed, was found to be unnecessary in 430 major, consecutive cases. In 2946 consecutive minor operations, an haemoglobin assay was found to be indicated in only 8 cases though it was done in all. Nasogastric tubes, urinary catheters and drains were found unnecessary in over 500 cases in one year. Vigilance in other areas such as use of I.V. fluids, I.V. drugs, antibiotics and wound dressings could significantly reduce health care cost. Attention must be paid to cost attainment if we are to continue to provide good care at affordable cost (AU)
Assuntos
Humanos , Cirurgia Geral , Economia Médica , Trinidad e TobagoRESUMO
Thyroidectomy, to date, remains a procedure accompanied by a morbid fear of haemorrhage. This is translate in clinical practice with the routine use of drains and hospitalization for observation post-operatively. Following our favourable experience of performing thyroidectomy without drainage, we embarked on a trial of "same day thyroidectomy", where the patient is discharged home on recovery from anaesthesia. During the 5-year study (1982-1992), 41 thyroidectomies were performed for non-toxic goitre. These comprised 12 unilateral total lobectomies, 7 unilateral subtotal lobectomies, 14 bilateral subtotal lobectomies and 5 isthmic excisions. No drains were used and patients were allowed to leave on recovery from anaesthesia (average 6 hours). There were no cases haemorrhages or deaths, no wound infections, no haematomas and no cases of recurrent laryngeal nerve injury. Same day thyroidectomy is a safe and cost-effective procedure for non-toxic thyroid goitre (AU)
Assuntos
Humanos , Tireoidectomia/tendências , Tempo de Internação/tendênciasRESUMO
In a prospective 2-week survey of 4,041 consecutive admissions to the accident and emergency service at the Port-of-Spain General Hospital, 1,458 cases were related to trauma (36 percent). There were 964 males (66.1 percent) and 494 females (33.9 percent). The home was the most common site of trauma; 571 (39.2 percent) and (67 percent) of the injured were between the ages of 15 and 64 years. The total number of motor vehicle accidents was 201, of which 61 involved pedestrians (13.8 percent). Assault incurring blunt or penetrating trauma consisted of 293 cases (20 percent). The most common injury was related to the soft tissues (33 percent) contusion, abrasion, ligamentous strain; followed by lacerations (19.3 percent) and fractures (19 percent). Direct penetrating injuries accounted for only 35 cases (2.4 percent); 43.7 percent of patients had radiological and 3.4 percent had haematological investigations, compared withe 13 percent and 13.4 percent respectively of non-traumatic admissions. Ward admissions in the trauma and non-trauma groups were, however, similar (40 percent). This large database would be useful for future strategy, in the prevention and provision of emergency care in the West Indies (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Ferimentos e Lesões/epidemiologia , Trinidad e TobagoRESUMO
Recurrence-free repair of midline vntral abdominal wall hernia continues to elude surgeons, despite the abundance of described techniques. Based on the observation that spontaneous herniation through the rectus abdominis muscles is unknown, a new technique of repair was devised. The rectus muscles and their sheaths on either side of the hernial drfect are directly brought together to obliterate the hernia, the intervening linea alba and intact hernia sac being 'keeled' into the abdominal cavity. Using this technique, 85 consecutive midline abdominal hernias were repaired over an 11-year period. Follow-up was from 18 months to 12 years; there was one recurrence. The rectus repair is recommended as an effective method of dealing with ventral midline abdominal wall hernia (AU)
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Feminino , Músculos Abdominais/cirurgia , Hérnia Ventral/cirurgia , Recidiva , Técnicas de SuturaRESUMO
Twenty-two consecutive patients with obstructing left colonic carcinoma underwent resection of the tumour and colocolic anastomosis, without intra-operative colonic lavage. There were two wound infections (9 per cent) but no anastomotic leaks or intra-abdominal abscesses. One death occurred 12 hours following surgery. At postmortem, the cause was attributed to myocardial infarction. The average duration of hospitalization was 8 days. Emergency surgery on the obstructed left colon can be safely carried out without intra-operative colonic lavage (AU)