RESUMO
During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided. (AU)
Assuntos
Humanos , Masculino , Feminino , Fraturas Ósseas/complicações , Embolia Gordurosa/terapia , Cuidados Críticos , Doenças do Sistema Nervoso Central/etiologia , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/etiologia , Transtornos Respiratórios/etiologiaRESUMO
During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided.
Assuntos
Humanos , Masculino , Feminino , Embolia Gordurosa/terapia , Fraturas Ósseas/complicações , Transtornos Respiratórios/etiologia , Doenças do Sistema Nervoso Central/etiologia , Cuidados Críticos , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/etiologiaRESUMO
Forty-five patients with myasthenia gravis (MG) were subjected to thymectomy by the median sternotomy technique and were followed up for 4,380 patient months. No operative deaths occurred and 93.3 percent of the patients benefited from surgery with 28.8 percent achieving remission. Forty patients (88.5 percent) showed improvement within one month, and 73 percent of those who achieved remission did so in the first 2 years. Outcome was not affected by thymic pathology except in one patient who had a thymoma removed. These results confirm the value of thymectomy in the management of MG patients with generalised disease and the efficacy of the simple median sternotomy procedure (AU)
Assuntos
Humanos , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Feminino , Miastenia Gravis/cirurgia , Timectomia , Prognóstico , Indução de Remissão , Jamaica , Seguimentos , Fatores de Tempo , Resultado do Tratamento , Hiperplasia do Timo/cirurgia , Miastenia Gravis/patologia , Hiperplasia do Timo/patologiaRESUMO
Clinical, immunological and genetic parameters were studied in 73 Jamaican patients with myasthenia gravis (Mg). The reported biomodal clinical distribution of females with early onset of disease and males with late onset was not observed. The female to male ratio was 2:1. The most frequent manifestations of disease were ptosis (84.9 percent), general muscle weakness (68.5 percent), bulbar symptoms (41.1 percent) and diplopia (32.9 percent). Unusual presenting features such as unilateral ptosis, recurrent chest infection and stumbling while walking resulted in diagnosis being missed in 5.8 percent of cases. The sensitivity of radiommunoassay in detecting acetylcholine receptor antibody (AchR-Ab) in sera from a subgroup of 35 MG patients was 71.4 percent whilst that of the ELISA was only 14.2 percent. There was no correlation between HLA-type, thymic pathology and course of disease. HTLV-I could not be implicated in the pathogenesis of this disease. There was a paucity of other associated autoimmune conditions among MG patients. Thymectomy was an important therapeutic modality in that improvement was observered in 22 cases and remission in 11. (AU)
Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Feminino , Miastenia Gravis/diagnóstico , Miastenia Gravis/imunologia , Timo/cirurgia , Blefaroptose , Diplopia , Receptores Colinérgicos/sangue , Índice de Gravidade de DoençaRESUMO
A retrospective study of all patients subjected to closed mitral valve commissurotomy from 1955 to 1985 at the University Hospital revealed low morbidity and mortality rates associated with surgery. Out-patient follow-up studies indicate adequate symptomatic relief over a period of 1 to 27 years. Patients with isolated significant mitral stenosis should, therefore, be considered for surgical palliation (AU)
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Complicações Pós-Operatórias , Índias OcidentaisRESUMO
Mitral stenosis (MS) is not infrequently seen in patients presenting at referral clinics in the University Hospital (UH). These patients are offered surgical palliation - Closed mitral commissurotomy (CMC) - as published reports indicate such therapy is quite satisfactory. A study of all patients subjected to CMC for MS at UH was undertaken to evaluate the results of this operation. There were 97 women and 23 men and their ages ranged from 9 to 57 years (mean 24.7). A clinical diagnosis of MS was made in all patients. Thirty-four and 28 patients were subjected to cardiac catheterisation and echocardiography respectively to confirm the clinical diagnosis and /or to exclude other cardio-vascular abnormalities. The operative procedures performed were as follows: CMC - 117, CMC + lung biopsy - 1, Thoracotomy - 1, Prosthetic aortic and mitral valve replacement (failed CMC) - 1, Total = 120; Subsequent operations performed were as follows:- CMC - 1, Homograft mitral valve replacement - 5, Porcine xenograft mitral valve replacement - 3, Tracheostomy - 1, Thoracotomy (tamponade2, no tamponade 2) - 4, Total = 14. There were 3 intra-operative deaths (left coronary embolus, bleeding, acute cardiac failure), a 2.5 per cent mortality. Five and 9 patients died in the early and late post-operative periods respectively (cardiac failure, systemic embolisation, re-stenosis, re-operative), 4.2 and 7.5 per cent mortality. Follow-up studies after CMC indicate adequate symptomatoic relief over a period of 1 to 27 years. The results of CMC at UH indicate that the techniques of anaesthesia and surgery are associated with low morbidity and mortality. Patients with MS should therefore be considered for surgical palliation (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Estenose da Valva Mitral/terapia , Valva Mitral/cirurgia , JamaicaRESUMO
A case of left atrial myxoma presenting as acute pulmonary oedema is described. As far as we are aware, this is the report in the West Indian medical literature of accurate pre-operative diagnosis and successful surgical excision of such a tumour. Recent improvements in the accuracy of pre-operative diagnosis are discussed, and the present day availability of surgical excision, utilising cardio-pulmonary bypass with excellent post-operative results at low-risk, make response of this case of considerable importance. (AU)
Assuntos
Masculino , Humanos , Pessoa de Meia-Idade , Neoplasias Cardíacas/complicações , Mixoma/complicações , Edema Pulmonar/etiologia , Doença Aguda , Átrios do Coração , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Mixoma/patologia , Mixoma/cirurgia , JamaicaRESUMO
A retrospective study of all patients with patent ductus arteriosus treated surgically from 1953 to 1984 at the University and National Chest Hospitals revealed low morbidity and mortality rates associated with anaesthesia and surgical treatment. Patients with patent ductus arteriosus should, therefore, be considered for surgical correction. (AU)
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Permeabilidade do Canal Arterial/cirurgia , Anestesia , Permeabilidade do Canal Arterial/mortalidade , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Patent ductus arteriosus (PDA) is frequently seen in children presenting at referral clinics. These children are offered surgical correction as published reports indicate such therapy is quite satisfactory. This study reports the results of operative intervention (1953 to 1984) at the University Hospital (UH) and National Chest Hospital (NCH). A study of all children (<13 years) subjected to surgical correction of PDA was undertaken to evaluate the results of this operation. There were 140 females and 72 males and their ages ranged from a few weeks to 12 years (mean 4.6 years). A clinical diagnosis of PDA was made in all patients. Forty-two children were subjected to cardiac catheterisation to confirm the clinical diagnosis and/or to exclude other cardio-vascular abnormalities. Anaesthetic management included a balanced technique and induced moderate arterial hypotension to facilitate the great vessel surgery. The operative procedures performed were as follows:- PDA division + suture - 151; PDA ligitation - 48; PDA division + suture & coarctation repair - 5; PDA division + suture & sub-aortic stenosis repair (OHS) - 1; PDA aneurysm repair with LA-femoral bypass - 1; No PDA at thoracotomy - 6, --division of ligamentum arteriosum, --repair of aorto-pulmonary fistulae (OHS) -1, --subsequent repair of VSD (OHS). (OHS = open heart surgery with cardio-pulmonary bypass). There was 1 intra-operative death (<0.5 per cent mortality) due to bleeding from a torn ductus (in 1965) and 1 post-operative death (<0.5 per cent mortality) caused by digoxin toxicity which occurred on day 1 in the convalescent ward. The clinical diagnosis of PDA is accurate (96.5 per cent), and the techniques of anaesthesia and surgery are associated with low morbidity and mortality. Children with PDA should therefore be considered for surgical correction (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Lactente , Pré-Escolar , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/cirurgia , Índias Ocidentais , Avaliação de Resultado de Intervenções TerapêuticasRESUMO
Hepatic structure and function of 22 unselected patients with early syphilis was assessed. In 20 (91 percent) routine hepatic tests or bromsulphalein retention showed mild non-specific abnormalties. Minor changes in hepatic structure were present in 12 (55 percent), in three of whom intrahepatic spirochaetes were found. The only patient who had hepatomegaly also had splenomegaly. Observed changes in hepatic structure correlated with neither physical signs nor results of biochemical tests. Hepatic changes in early syphilis are common but frequently subclinical (AU)