Examination performance of medical students: a view from Trinidad

We analysed the outcome of the final MBBS (Bachelor of Medicine and Bachelor of Surgery) examination oat the St. Augustine Campus, University of the West Indies, for 686 students attempting them for the first time between 1975 and 1986. The mean failure rate was lowest in medicine between 1975 and 1981, in obstetrics and gynaecology between 1982 and 1989 and in surgery during the last 7 years. The students' poor performance in some areas indicates the need for recognizing the importance of creating and establishing an educational climate in which the quality of teaching comes under scrutiny. The marking system in medicine should be reviewed.

The results of abdominal myomectomy

A survey of the records of 103 consecutive patients who underwent abdominal myomectomy revealed that menorrhagia and infertility were the commonest presenting complaints. The overall successful pregnancy rate was only 28.8 per cent , but the procedure was corrective in two-thirds of patients with leiomyomata-related infertility. Intra-operative blood loss, post-operative adhesion formation and recurrence of tumour remain major drawbacks of myomectomy

An audit of eclampsia

One hundred and three patients with eclampsia were managed during a period of eleven years. The perinatal mortality rate was 136 per 1000 total births and there were six maternal deaths. The maternal mortality rate was less among eclamptics delivered by Caesarean Section. Liberal use of diazepam and magnesium sulphate and early recouse to Caesarean Section were integral in the care of these women.

Risk factors and treatment of endometrial carcinoma

A twelve-year retrospective study of 54 consecutive cases of endometrial carcinoma revealed that post-menopausal bleeding was the commonest symptom, and the major associated risk factors were obesity and hypertension. Panhysterectomy was the corner-stone of treatment while adjunctive therapy was based on certain prognostic factors and the operator's preference.

Cold-knife cervical conization

Forty-six cervical conizations were performed over a ten-year period for diagnostic or therapeutic purposes. Twenty-nine women were under 45 years of age. The most common reason for conization was an abnormal Papanicolaou smear. The overall incidence of neoplasia was 80.4 per cent. The high complication rate of 28.4 per cent emphasizes the need for a less traumatic technique of excisional biopsy.

Haemothorax and ascites associated with endometriosis

A young patient with pleuroperitoneal endometriosis presented with an haemorrhagic effusion. Two years later, she developed massive ascites with resolved after treatment with oral Danazol and Depo-Provera injections.

Is adolescent pregnancy hazardous?

A study of the pregnancy outcome in 3320 teenagers revealed a low incidence of pre-eclampsia and anaemia and high rates of eclampsia, prematurity and low birthweight. The perinatal loss was 2.2 per cent and there was one maternal death. A comprehensive programme designed to improve antenatal surveillance is recommended for adolescents.

Peripartum cardiomyopathy and arterial embolism

A severely pre-eclamptic patient developed peripartum cardiomyopathy and bilateral femmoral emboli. Medical therapy for cardiac failure was commenced prior to delivery by Caesarean Section. Bilateral femoral embolectomy was performed on the sixth postpartum day.