Outcome of stage I carcinoma of the breast at the University Hospital of the West Indies (1982-1988)

The five-year survival data for 62 patients with Stage I breast cancer treated at the University Hospital of the West Indies (UHWI) between 1982 and 1988 were evaluated to determine which factors were affecting outcome. The overall survival rates (66.7 per cent ) were below those quoted from large multicentre studies from North America, Western Europe and Australia. The most significant survival differences emerged in the subset of postmenopausal patients with cliniclly staged disease who fared worse than those with pathologically staged disease. These data suggest that clinical staging is inadequate for the management of Stage I breast cancer. Consistent pathological staging, utilization of other prognostic predicators, and systemic therapy on a more widespread scale may help to improve the clinical outcome

Wiskott-Aldrich Syndrome in a Jamaican

A 3-week-old boy presented with severe thrombocytopenia and recurrent infections. He was subsequently found to have Wiskott-Aldrich Syndrome, a rare X-linked disorder. Splenectomy was performed and he died of post-splenectomy sepsis despite prophylatic antibiotic therapy. This is the first recorded case in the English-speaking Caribbean.

Use by visitors of the services of the Queen Elizabeth Hospital, Barbados, W.I

This paper analyses data for 1990 culled from the medical records of the Queen Elizabeth Hospital, Barbados and examines the use of inpatient and emergency services by visitors to Barbados. The 473 visitors admitted represented 2.1 per cent of all admissions. The records of 425 contained information on country of origin: 145 were from non-Caribbean and 280 from Caribbean countries. The distribution by country of non-Caribbean visitors was the same as that of regular tourist arrivals - The majority came from the USA, Canada and the UK. Caribbean visitors represented 14.4 per cent of the tourists, but accounted for 65.9 per cent of visitor admissions. Non-Caribbean visitors were 85.6 per cent of tourists, but 34.1 per cent of admissions. Young patients predominated among Caribbean, and older patients among non-Caribbean. Accidents, cardiovascular disease, alcohol-related illnesses and near drowning were commoner in the non-Caribbean visitors, while cancer and obstetrical/gynaecological problems were commoner in Caribbean visitors. Seven per cent of visitor admissions went to the Intensive Care Unit as against 0.15 per cent of other patients. The average hospital stay of visitors was 11.7 days compared with 7.0 days for Barbadians. There were 898 visitors treated in the Accident and Emergency Department and the commonest problems were lacerations, abrasions and infections. The UK provided most of these patients. These data show that there is appreciable visitor use of the public health services. Non-Caribbean visitors use them because they fall ill on holiday, but many Caribbean visitors may come specifically for health care. The cost to the Barbadian health service is not insignificant: at the 1990 estimated bed-day cost of Bds$250, it represents a cost of Bds$1.1 million per annum to the Government for inpatient services alone, or 2 per cent of total hospital costs.