Patterns of trauma injuries in rural versus urban Jamaica

Trauma admissions to St Ann's Bay Hospital in rural Jamaica and The University Hospital of the West Indies (UHWI) in the capital city of Kingston are compared. Trauma accounted for 19 and 22 of surgical admissions to UHWI and the St Ann's Bay Hospital, respectively. Sixty-three per cent of trauma cases admitted to the St Ann's Bay Hospital and 56 to the UHWI were due to unintentional injuries (95 CI, -0.05, 0.19). The main cause of unintentional injuries at both hospitals was motor vehicle accidents, accounting for 43 and 37 at UHWI and St Ann's Bay Hospital respectively (95 CI, -0.04, 0.17). The prevalence of falls was significantly higher in St Ann's Bay Hospital compared with UHWI, 41 and 26 respectively (95 CI, 0.10, 0.21). Intentional injuries accounted for 37 of cases in St Ann's Bay Hospital and 44 at UHWI (95 CI, -0.20, 0.04). The prevalence of firearm injuries was significantly higher at the UHWI than in St Ann's Bay Hospital, 55 and 18 respectively (95 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.

Incarcerated obturador hernia

Incarcerated obturator hernia is rara, only approcimately 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 womwn and they almost always present with symptoms and signs of small bowel obstruction. Pressure on the abturator nerve by the hernial sac in the obturator canal results in a positive Howship-Romberg sign in about 50% of patients. If the diagnosis is suspected pre-operatively, confirmation may be obrained by computerized tomography. this, hower, seems unnecessary as prompt exploration is advisable due to the high incidence of gangrene of the vowel. At surgery 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