Bilateral psoas abscess in a case of granuloma inguinale / Absceso bilateral de psoas en un caso de granuloma inguinal

The authors present a case of disseminated granuloma inguinale with bilateral psoas abscesses. Infection with calymmatobacterium granulomatis is usually localized to the genital organs but rarely may be disseminated. A search of the literature revealed that only two cases of psoas abscesses due to calymmatobacterium granulomatis were previously reported.

Los autores presentan un caso de granuloma inguinal diseminado con abscesos bilaterales de psoas. La infección con calymmatobacterium granulomatis normalmente se localiza en los órganos genitales, y raramente se disemina. La literatura reveló sólo dos casos de abscesos de psoas debidos a calymmatobacterium granulomatis reportados con anterioridad.

Anaesthesia for operative deliveries at the University Hospital of the West Indies: a change of practice / La Anestesia en los Partos Operativos en el Hospital Universitario de West Indies Un Cambio de Práctica

There has been an increasing trend worldwide to use regional anaesthesia for operative deliveries. The Confidential Enquiry into Maternal Deaths in the United Kingdom has demonstrated a steady decline in the anaesthesia-related deaths since the introduction of regional anaesthesia. There are lower morbidity profiles in mothers delivering under regional anaesthesia as well as better infant Apgar scores. In 1997, a decision was taken to have at least 60% of all elective Caesarean sections done at the University Hospital of the West Indies (UHWI) performed under spinal anaesthesia. This is a review of the anaesthetic technique for Caesarean sections at the UHWI since 1996. The Deliveries and Anaesthetic Books on the labour ward were reviewed and the type of anaesthesia for elective and emergency Caesarean sections recorded for the period January 1996 to December 2001. At the beginning of the period under study, more than 90% of the Caesarean sections were being done under general anaesthesia. By the middle of 1998, spinal anaesthesia was more commonly employed than general anaesthesia for Caesarean sections and by December 2001, more than eight out of every ten Caesarean sections were being done under spinal anaesthesia. The main reasons for the successful change of practice were that it was consultant-led, there was good communication between relevant departments, the junior staff were properly trained, there was a consistent supply of appropriate drugs and there was a high level of patient satisfaction

Ha habido una tendencia creciente mundial a usar la anestesia regional en los partos operativos. La Encuesta Confidencial sobre las causas de las muertes maternas en el Reino Unido, ha demostrado un descenso constante de los casos de muertes relacionadas con la anestesia, a partir de la introducción de la anestesia regional. Los perfiles de morbosidad son más bajos en las madres que dan a luz con anestesia regional, en tanto que los infantes presentan una mejor puntuación Apgar. En 1997, se toma la decisión de que al menos el 60% de todas las secciones cesáreas electivas en el Hospital Universitario de West Indies (UHWI) fueran realizadas bajo anestesia espinal. El presente trabajo constituye un resumen que examina la técnica anestésica aplicada en las cesáreas practicadas en el UHWI desde 1996. Se examinaron los Registros de Partos y Anestesia del salón de partos, tomándose nota del tipo de anestesia usado en las cesáreas electivas y de emergencia en el período de enero de 1996 a diciembre de 2001. A principios del periodo bajo estudio, más del 90% de las secciones cesáreas se hacían con anestesia general. A mediados de 1998, la anestesia espinal se empleaba más comúnmente que la anestesia general en las cesáreas. Y para diciembre de 2001 más de ocho de cada diez cesáreas se realizaban con anestesia espinal. Las razones principales para el cambio exitoso de práctica consistieron en que se llevo a cabo bajo la dirección de un consultante, hubo buena comunicación entre los departamentos pertinentes, el personal subalterno estaba debidamente entrenado, hubo un suministro consistente de los medicamentos apropiados, y finalmente un alto nivel de satisfacción de los pacientes.

Who is at high risk? A comparison of the seroprevalence of human immunodeficiency virus in pregnant women and a high risk group

To compare the seroprevalence of HIV in Jamaican pregnant women with that in substance abusers, two groups of antenatal patients were studied, one (A) attending a public hospital clinic and the other (B) attending private clinics. The HIV seroprevalence in the antenatal patients was compared with that in the substance abusers, group C, in 1996 and five years later in 2001. HIV antibody was determined by enzyme immunoassay. The HIV seroprevalence in group A more than doubled (1.6-3.8) in five-years, 1996-2001. There were no seropositives in group B. In group C, the seroprevalence rose from 2.08 in 1996 to 5.76 in 2001. There was indication that group A might no longer be considered [quot ]low risk[quot ], as there was no significant difference from group C in HIV seroprevalence in 1996 and 2001. The trend seen in this study is worthy of further investigation

Transverse ureterotomy in open ureterolithotomy

Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy

Disseminated donovanosis (granuloma inguinale) with osteomyelitis of both wrists

Donovanosis is a sexually transmitted infection which presents with genital ulceration and inguinal lymphadenopathy. Rarely, it presents with extra-genital manifestations. We present a case of disseminated donovanosis with cervical ulceration, massive pelvic lymphadenopathy, osteomyelitis of the wrists and septic arthritis of the knees and right elbow. A 23-year-old gravida two presented with wasting, oedema, ascites, bilateral iliac lymphadenopathy, anaemia and a large ulcer of the cervix uteri. Two months later in the outpatient clinic, she was much improved but still had post-coital bleeding and a hyperaemic cervix, suggestive of persistent infection. The course of antibiotics was therefore repeated. Histopathological examination of a specimen from colposcopic biopsy of the cervix uteri revealed granuloma inguinale. She improved after several courses of antibiotics, blood transfusion, surgical dÚbridement and aspiration of affected joints.

HIV infection seroprevalence and risk factor study among pregnant women attending the Antenatal Clinic at the University Hospital of the West Indies, Kingston, Jamaica

The objectives of this study were to determine the seroprevalence and risk factors for Human Immunodeficiency Virus (HIV) infection among the antenatal clinic population at the University Hospital of the West Indies (UHWI). Pregnant mothers (4186) attending antenatal clinic at the UHWI were screened for HIV infection between September, 1998, and October, 2000. Tests were performed with the use of Abbott enzyme immunoassay (EIA) kits for the detection of antibodies to HIV 1 and 2. Demographic characteristics and risk factor assessments were performed using a questionnaire for all positive cases and four randomly selected negative controls matched by age to each positive case. Twenty-one women were found to be HIV positive. Nineteen of these women were not previously aware that they were HIV-positive. The seroprevalence of HIV infection among antenatal mothers was 0.5. The mean age of cases was 29.3 +/- 4.6 years. There was no significant difference between cases and controls with regards to parity, socio-economic status and educational achievement. Women residing in urban Kingston and St Andrew (Odds ratio (OR) 5, 95 confidence interval (CI) 1.4, 18), as well as those with a higher number of lifetime sexual partners (OR 1.42, 95 CI 1.13, 1.79) and those with previous sexually transmitted diseases (OR 3.4, 95 CI 1.1, 10.6) were at greater risk for HIV infection. In contrast, women who commenced coitus at a later age were at less risk of becoming infected (OR 0.79, 95 CI 0.6, 0.97). This study demonstrates a low seroprevalence of HIV in the UHWI antenatal population compared to the reported seroprevalence of 2-8 in pregnant women in Latin America and the Caribbean. The results from this study emphasize the continuing need for voluntary HIV testing and HIV/AIDS educational campaign for this vulnerable group.

The mid-forearm arteriovenous fistula as vascular access for haemodialysis

Successful chronic haemodialysis requires permanent vascular access. The Scribner procedure which utilizes an external arteriovenous shunt, the internal synthetic arteriovenous shunt and the direct arteriovenous fistula as described by Cimino and Brescia have all been used for haemodialysis. Of the three methods, the arteriovenous fistula is the most trouble-free and durable. However, as originally described and constructed in the distal forearm, the morbidity associated with this method is significant. The cubital fossa fistula has even more problems. The mid-forearm fistula was designed by the authors and has been used for chronic haemodialysis over the past eighteen years. This article compares the various methods of access used in the haemodialysis units of the University Hospital of the West Indies and the Kingston Regional Hospital. The mid-forearm fistula was found to have the lowest initial failure rate and was associated with fewer complications than any of the other methods used for access.