ABSTRACT
INTRODUTION: The incidence of colorectal cancer in India is lower compared to the Western world. In Western countries, most cases of colorectal cancer are sporadic and the hereditary variety accounts for only 10‑15% of all cases. The aim of the present review is to determine the clinical and epidemiological characteristics of hereditary colorectal cancer in India. MATERIALS AND METHODS: A Medline search was conducted to review the literature published from India regarding colorectal cancer. The keywords used included India, colorectal cancer, hereditary nonpolyposis, and familial adenomatous polyposis. All relevant articles were reviewed and the characteristic features of this disease in Indian population were collated and presented. RESULTS: Literature search revealed eighty two articles pertinent to India, of which only ten articles had relevant information on hereditary cancers. Although the overall incidence of colorectal cancer was low in both genders, there were a high proportion of patients developing colorectal cancer before the age of 45 years. Additionally, there was a higher proportion (10‑15%) of hereditary nonpolyposis colorectal cancer cases, as confirmed by microsatellite instability. CONCLUSION: The overall incidence of colorectal cancer is low in India. There is a tendency to affect a relatively younger age group, and we infer that the incidence of hereditary colorectal cancer is high and is similar to the Western countries.
ABSTRACT
OBJECTIVE: The first world witnessed a laparoscopic revolution in the 1990s. At the start, laparoscopic surgery was heavily criticized and ridiculed. Despite this, the specialty has blossomed where almost any procedure can be done laparoscopically with the now obvious tremendous benefit to the patients. The objective of this paper is to examine where the Caribbean is placed relative to the rest of the world in terms of laparoscopic surgery and to understand why we are here. DESIGN AND METHODS: The literature written on laparoscopy in the region was reviewed and contributions were taken from key surgeons in three main islands, Trinidad and Tobago, Barbados and Jamaica. RESULTS: Though the first laparoscopic cholecystectomy in the Caribbean, in most islands, took place in the early 1990s like the rest of the world, there was relative dormancy for at least a decade in Trinidad and Tobago and even longer in other islands with regards to implementing advanced procedures or increasing case volumes. Reasons for this included lack of funding, lack of operating time in public facilities, lack of information of the public and the medical fraternity but most importantly lack of trained laparoscopic surgeons. This last factor was proven to be the key one in Trinidad and Tobago in 2003, Jamaica 2005 and Barbados 2011/12, when the return of trained personel engineered the transition from basic to advanced laparoscopy. CONCLUSION: Despite the delay of approximately 10 years in Trinidad and Tobago and 15 years in other islands, the return of trained surgeons has seen a rapid increase in case variety and volumes in laparoscopy. The wheels of motion of the laparoscopic revolution in the Caribbean have finally begun.
OBJETIVO: El primer mundo fue testigo de una revolución laparoscópica en los años 1990. Al comienzo, la cirugía laparoscópica fue muy criticada y ridiculizada. A pesar de ello, la especialidad ha florecido, siendo el caso que ahora casi cualquier procedimiento puede hacerse laparoscópicamente, con evidentes grandes beneficios para los pacientes. El objetivo de este trabajo es examinar donde se encuentra el Caribe en relación con el resto del mundo en lo que se refiere a la cirugía laparoscópica, y asimismo el por qué nos hallamos en ese lugar. DISEÑO Y MÉTODOS: Se examinó la literatura sobre laparoscopia escrita en la región, y se tomaron contribuciones de cirujanos claves de tres islas principales, a saber, Trinidad y Tobago, Barbados y Jamaica. RESULTADOS: Aunque las primeras colecistectomías laparoscópicas en la mayoría de las islas del Caribe, tuvieron lugar a principio de los años 1990 como en el resto del mundo, hubo un período de relativa inactividad por espacio de casi una década en Trinidad y Tobago, y aun por más largo tiempo en otras islas, en relación con la implementación de procedimientos avanzados o el aumento del volumen de casos. Las razones para esta relativa inactividad incluyeron la falta de fondos, la falta de tiempo de operación de los centros públicos, la falta de información del público y la fraternidad médica, pero sobre todo la falta de cirujanos entrenados en laparoscopia. Esto ultimo resultó ser el factor clave en Trinidad y Tobago en 2003, Jamaica en 2005 y Barbados en 2011/12, cuando el regreso del personal entrenado hizo técnicamente posible la transición de una laparoscopia básica a una avanzada. CONCLUSIÓN: A pesar de la demora de aproximadamente 10 años en Trinidad and Tobago, y de 15 años en las otras islas, el regreso de los cirujanos entrenados ha visto un rápido aumento en la variedad casos y los volúmenes de laparoscopia. El motor de la revolución laparoscópica en el Caribe ha por fin echado a andar.
Subject(s)
History, 20th Century , Humans , General Surgery/education , Laparoscopy/history , Cholecystectomy, Laparoscopic/history , Laparoscopy/education , West IndiesABSTRACT
Sentinel lymph nodes (SLNs) are the nodes in direct communication with the primary tumor and are therefore the first group of nodes to be involved in lymphatic metastasis. Though the role of SLN biopsy is well established in cancers of the breast and melanoma, its role in gastrointestinal malignancies is still evolving and controversial. In this paper, the literature is reviewed with respect to the status of SLN biopsy in gastrointestinal malignancies.
ABSTRACT
A 16-year old female presented to hospital with abdominal pain. Features on computed tomography raised the possibility of biliary cystadenoma or cystadenocarcinoma. She underwent a liver resection, and histopathology confirmed a serous biliary cystadenoma. This case is presented to highlight the radiological features of this uncommon pre-malignant condition as well as to summarize a management algorithm for cystic liver lesions.
Una mujer de 16 años de edad acudió al hospital con un dolor abdominal. Las características observadas con tomografía computarizada apuntaban a un cistoadenoma biliar o un cistoadenocarcinoma como diagnósticos diferenciales. La paciente fue sometida a una resección del hígado, y la histopatología confirmó un cistoadenoma biliar seroso. Presentamos este caso para resaltar los rasgos radiológicos de esta condición premaligna rara, así como para resumir un algoritmo de tratamiento para las lesiones císticas de hígado.
Subject(s)
Adolescent , Female , Humans , Biliary Tract Neoplasms , Cystadenoma, Serous , Tomography, X-Ray Computed , Algorithms , Cystadenoma, Serous/pathology , Diagnosis, Differential , Magnetic Resonance ImagingABSTRACT
OBJECTIVE: The purpose of this study was to establish baseline data for a procedure that has yet to be defined within a Caribbean population. Using a specifically designed postoperative questionnaire, symptomatology and quality of life were assessed before and after laparoscopic Nissen fundoplication. METHODS: Twenty-three consecutive patients of the same surgeon were identified. The questionnaires measured the symptoms and social and emotional functioning, assigning each a score for comparative purposes. The cumulative score was considered the ultimate index of overall quality of life. Wilcoxon matched pairs test was used to analyse the data. RESULTS: The mean age of the patients was 47.5 years. There were 21 females and 2 males. Heartburn (78.3%) and regurgitation (60.8%) were the main symptoms. Postoperatively, these decreased to 17.3% and 4.3% respectively, with significant declines in other complaints such as dysphagia and nausea. The social and emotional functioning score had an average of 13.2 preoperatively; this increased to 18.3, postoperatively, out of a possible maximum of 20. None of the procedures had to be converted to open laparotomy and mean operating time was 108 minutes. Mean follow-up time was 9.7 months. CONCLUSION: Laparoscopic Nissen fundoplication does provide significant improvement in overall quality of life among patients with gastrointestinal symptoms and can be performed effectively within a Caribbean setting.
OBJETIVO: El propósito de este estudio fue establecer los datos básicos para un procedimiento que tiene que ser definido todavía en el contexto de una población caribeña. Usando una encuesta postoperatoria específicamente diseñada, la sintomatología y la calidad de vida fueron evaluadas antes y después de la fundoplicación laparoscópica de Nissen. MÉTODOS: Se identificaron veintitrés pacientes consecutivos del mismo cirujano. Las encuestas midieron los síntomas así como el funcionamiento social y emocional, asignando a cada uno una puntuación a fin de establecer comparaciones. La puntuación cumulativa fue considerada el índice final de la calidad general de vida. La prueba de pares equiparados de Wilcoxon se usó para analizar los datos. RESULTADOS: La edad promedio de los pacientes (21 hembras y 2 varones) fue 47.5 años. La acidez estomacal (78.3%) y la regurgitación (60.8%) fueron los síntomas principales. Postoperatoriamente, éstos disminuyeron a 17.3% y 4.3% respectivamente, con disminuciones significativas en el caso de otras dolencias, tales como la disfagia y la náusea. La puntuación del funcionamiento social y emocional tuvo un promedio de 13.2 preoperatoriamente. Este aumentó a 18.3 postoperatoriamente, de un máximo posible de 20. Ninguno de los procedimientos tuvo que ser convertido a laparotomía abierta y el tiempo promedio de operación fue de 108 minutos. El tiempo promedio de seguimiento fue de 9.7 meses. CONCLUSIÓN: La fundoplicación laparoscópica de Nissen proporciona un mejoramiento significativo de la calidad general de vida entre los pacientes con síntomas GI y puede realizarse de modo efectivo en un contexto caribeño.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Fundoplication/methods , Gastroesophageal Reflux/surgery , Quality of Life , Fundoplication/psychology , Gastroesophageal Reflux/psychology , Postoperative Complications , Surveys and Questionnaires , Statistics, NonparametricABSTRACT
The aim of this study is to examine the effectiveness with which Heller's myotomy can be performed laparoscopically in a Caribbean setting as a treatment for achalasia. Sixteen consecutive patients treated by the same surgeon were studied. Postoperative questionnaires that assessed symptomatology, complications and overall patient satisfaction with the procedure were utilized. The mean length of myotomy was 6cm and none was converted to an open procedure. The mean age of the eleven female and five male patients was 38.4 years. The mean duration of follow-up was 16.7 months. Symptoms showed an overall 71.2% improvement postoperatively (p < 0.001). Fifteen patients reported being satisfied with their operation with only one being dissatisfied. Intra-operative complications occurred in three patients. Estimated blood-loss (EBL) was minimal in each case. Intra- and postoperative mortality was zero. Laparoscopic Heller's myotomy can be effectively performed in local settings and should be considered as an alternative to the open approach in the treatment of all surgically-fit achalasia patients.
El objetivo de este estudio es examinar la efectividad con que la miotomía de Heller puede realizarse laparoscópicamente en un contexto caribeño como tratamiento para la acalasia. Se estudiaron dieciséis pacientes consecutivos, tratados por el mismo cirujano. Se utilizaron cuestionarios postoperatorios que evaluaron la sintomatología, las complicaciones y la satisfacción general del paciente con el procedimiento. La longitud promedio de la miotomía fue 6 cm y ninguno se convirtió en un procedimiento abierto. La edad promedio de las once pacientes hembra y los cinco pacientes varones fue 38.4 años. La duración promedio del seguimiento fue 16.7 meses. Los síntomas mostraron una mejora global de 71.2% postoperatoriamente (p < 0.001). Quince pacientes informaron estar satisfechos con su operación, en tanto que sólo uno manifestó descontento. Complicaciones intraoperatorias y postoperatorias ocurrieron en tres pacientes. La pérdida de sangre estimada (PSE) fue mínima en cada caso. La mortalidad, tanto intraoperatoria como postoperatoria, fue cero. La miotomía de Heller por vía laparoscópica puede realizarse de manera efectiva en escenarios locales y debe ser considerada como una alternativa al abordaje abierto en el tratamiento de todos los pacientes de acalasia sometibles a cirugía.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Esophageal Achalasia/surgery , Laparoscopy/methods , Health Status Indicators , Patient Satisfaction , Postoperative Complications , Prospective Studies , Surveys and Questionnaires , Minimally Invasive Surgical Procedures , Treatment Outcome , Trinidad and TobagoABSTRACT
An audit was conducted of pedicled flaps used in reconstructive surgery in Trinidad from 1983 to 2000. This consisted of 65 flaps. There were four cases of partial flap necrosis: three involving tram flaps and the other involving the metacarpal artery flap. There were no cases of total flap loss. Pedicled flap coverage provides immediate closure of potentially difficult wounds. This early cover reduces the risk of infection as a result of increasing the blood supply and providing a physical barrier. This contributes to a shorter hospital stay and earlier rehabilitation. Our present team approach with the inclusion of a reconstructive surgeon now allows for uncompromised dÚbridement in trauma and oncological resection.
Subject(s)
Female , Humans , Plastic Surgery Procedures , Surgical Flaps , Trinidad and Tobago , Retrospective Studies , Postoperative ComplicationsABSTRACT
We present an operation never described before for dealing with abdominal aortic aneurysms by exclusion via a midline trans-abdominal approach. This breakthrough holds many advantages over conventional aneurysmorrahphy and requires further clinical trials.
Subject(s)
Humans , Male , Aged , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/methods , Abdomen/surgery , Anastomosis, Surgical/methods , Iliac Aneurysm/surgery , Developing Countries , Blood Loss, Surgical/prevention & control , Peritoneum/surgerySubject(s)
Humans , Male , Aged , Prostatic Neoplasms/diagnosis , Prostate-Specific Antigen/analysis , Actuarial Analysis , Time Factors , Risk Assessment , Neoplasm Metastasis , Prostatic Neoplasms/economics , Prostatic Neoplasms/therapy , Mass Screening/economics , Treatment Outcome , Survival RateABSTRACT
Advanced Trauma Life Support (ATLS) training of medical staff did not improve outcome of the trauma victim. Potential benefit of this course may have been masked by weak links in the trauma care chain such as pre-hospital care and in hospital investigative and therapeutic facilities.
Subject(s)
Traumatology/education , Accidents, Traffic/mortality , Education, Medical, Continuing , Life Support Care , Trinidad and Tobago , Emergency Medical ServicesABSTRACT
Two handred and three patients were reviewed to assess the efficacy of diagtnostic uterine dilatation and curettage. Thirteen (6.4%) had definitive pathological changes of the endometrium; of the 4 patients with endometrial carcinoma, 3 presented eith post-menopausal bleeding. Anaemia was present in 11/3% of those with menorrhagia. The complication rate was 3.4% and the mean hospital stay, 3 days. It is suggested that in pre-menopausal women with abnormal uterine bleeding, medical management and outpatient endometrial biopsy should be the preferred diagnostic approach. fora post-menopausal women, curettage under general anaethesia remains the diagnostic method of choice
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Female , Uterine Hemorrhage/pathology , Dilatation and Curettage , Uterine Hemorrhage/etiology , Menopause , Age Factors , Evaluation Study , Endometrium/pathologyABSTRACT
Two cases of successful limb replantation are reported. The advantages of a team approcah and the basic requirements for beginning a replant programme are outlined