RESUMO
BACKGROUND: Although the Jamaica road traffic act mandates motorcycle riders to wear approved helmets, opponents suggest that the local road conditions obviate any benefits from helmet use that have been proven in Developed countries. They suggest that the narrow, winding, poorly surfaced, congested local highways do not allow motorcyclists to sustain high velocity travel. The accidents then tend to occur at lower speeds and are accompanied by less severe injuries. This study was carried out to determine the impact of helmet use on traumatic brain injuries from motorcycle collisions in patients admitted to a tertiary referral hospital in Jamaica. METHODS: A prospectively collected trauma registry maintained by the Department of Surgery at the University Hospital of the West Indies in Jamaica was accessed to identify all motorcycle collision victims from January 2000 to January 2007. The therapeutic outcomes of traumatic brain injuries were compared between helmeted and un-helmeted riders. The data was analyzed using SPSS Version 12. RESULTS: Of 293 motorcycle collision victims, 143 sustained brain injuries. There were 9 females (6.3%) with an average age of 23 +/- 7.3 years and 134 males (93.7%) at an average age of 33.4 +/- 11.2 years (mean +/- SD). Only 49 (34.3%) patients wore a helmet at the time of a collision. Helmet use at the time of a collision significantly reduced the severity of head injuries (28.6% vs 46.8%, P = 0.028) and the likelihood of sustaining intra-cranial lesions (26.5% vs 44.7%, P = 0.03) from head injuries. CONCLUSION: Wearing a helmet at the time of a motorcycle collision reduces the severity of head injuries. However, the prevalence of helmet use at the time of a collision is unacceptably low.
RESUMO
Granulomatous labour mastitis is a rare, benign, inflammatory breast condition of unknown aetiology that can clinically mimic breast cancer. Awareness of this condition is important, as the appropriate specimens must be taken to confirm the diagnosis and to rule out an infectious aetiology. While surgical exclusion has been the traditional therapeutic modality, the most appropriate therapy seems to involve the use of corticosteriods, even in the case of recurrence. (AU)
Assuntos
Adulto , Relatos de Casos , Feminino , Humanos , Granuloma/patologia , Mastite/patologia , Jamaica , Granuloma/cirurgia , Mastite/cirurgiaRESUMO
This paper reports two cases of benign hepatic cysts successfully treated by the instillation of tetracycline hydrochloride. The patients presented with solitary large symptomic hepatic cysts and underwent ultrasound guided needle aspiration followed by the instillation of tetracycline hydrochloride. The cyst size diminished without complication and the patients have remained symptom free. We review the treatment of this uncommon entity and propose that injection of tetracycline hydrochloride is an effective non-operative treatment of symptomatic solitary hepatic cysts. (AU)
Assuntos
Idoso , Humanos , Masculino , Relatos de Casos , Adolescente , Tetraciclinas/uso terapêutico , Cistos/terapia , Escleroterapia , Hepatopatias/terapia , /uso terapêutico , Drenagem , Idoso de 80 Anos ou mais , /administração & dosagem , Cistos/diagnóstico por imagem , Instilação de Medicamentos , Hepatopatias/diagnóstico por imagem , Tetraciclina/administração & dosagemRESUMO
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)
Assuntos
Adulto , Humanos , Feminino , Masculino , Estudo Comparativo , Ferimentos e Lesões/epidemiologia , Hospitais Rurais/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Escala de Gravidade do Ferimento , Jamaica/epidemiologia , Ferimentos e Lesões/etiologiaRESUMO
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/diagnósticoRESUMO
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 , Saúde da Criança/estatística & dados numéricos , Colecistostomia/estatística & dados numéricos , Colelitíase/epidemiologia , Colelitíase/cirurgia , Colecistostomia/mortalidade , Colelitíase/etiologia , Tratamento de Emergência , Jamaica/epidemiologia , PrevalênciaRESUMO
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 , DrenagemRESUMO
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.