A comparison of open and laparoscopic cholecystectomy done by a surgeon in training / Comparación de Colecistectomías abiertas y laparoscópicas realizadas por un cirujano durante su adiestramiento

Laparoscopic cholecystectomy has virtually replaced conventional open cholecystectomy as the gold standard for symptomatic cholelithiasis. The laparoscopic approach brings numerous advantages at the expense of higher complication rates, especially in training facilities. This comparative 18-month review examines the outcomes of 52 cholecystectomies performed by a single surgical resident at the University Hospital of the West Indies--a teaching hospital in Jamaica. The advantages of laparoscopic cholecystectomy have been demonstrated and it has been found to be safe and effective in this training facility.

La colecistectomía laparoscópica ha reemplazado virtualmente la colecistectomía abierta convencional, siendo ahora la norma de oro para la colelitiasis sintomática. El abordaje laparoscópico trae consigo numerosas ventajas a expensas de tasas de complicación más altas, sobre todo en las instalaciones de adiestramiento. Este estudio comparativo realizado a lo largo 18 meses, examina los resultados de 52 colecistectomías realizadas por un residente de cirugía del Hospital Universitario de West Indies – un hospital docente de Jamaica. Las ventajas de la colecistectomía laparoscópica han quedado demostradas, y el tratamiento ha probado ser seguro y efectivo en esta instalación docente.

Potential role for advanced trauma life support programme in improving trauma care in Jamaica

Data from the Road Safety Unit in the Ministry of Transport and Works, Jamaica, show an increase in road traffic accidents from 7861 in 1991 to 11,010 in 1999. The average number of deaths annually was 380 +/- 48 (SD) while injuries averaged 3320 +/- 262 per year. This represents an injury to death ratio of 8.7 compared with 24.9 for Trinidad and Tobago and 40 for Canada. During the period 1991 to 2000, an average of 796 +/- 159 (SD) murders were committed annually. The number of murders increased by over 280 per cent between the decade of the seventies and the nineties. Data from the trauma registry of the University Hospital of the West Indies showed that 29.6 per cent of all admissions to the surgical ward between January 1998 and December 31, 2000, were due to injuries. There were 97 deaths (3) during this period and 33 occurred in the Accident and Emergency Department with 70 per cent occurring within 120 minutes of their arrival. The Advanced Trauma Life Support (ATLS) Programme emphasizes the resuscitation and stabilization of injured patients in the first few hours after injury. Most Emergency Departments in Jamaica are staffed by relatively junior medical officers and the low injury to death ratio among victims of motor vehicle accidents may be due to suboptimal care. Introduction of an ATLS programme in Jamaica may reduce the number of preventable deaths and also stimulate interest in trauma care thus increasing preventative measures to decrease the high incidence of trauma in Jamaica

Pancreatitis and duodenal obstruction following abdominal aortic aneurysm repair

This paper reports one case of pancreatitis and duodenal obstruction that occurred following repair of an abdominal aortic aneurysm. The patient had neither antecedent biliary or pancreatic disease nor alcohol abuse. The presentation was mild and the patient had an uneventful recovery without surgery. We present this uncommon entity and review the available literature.

Compartment syndrome of the thigh. A case report and review of the literature

A case of compartment syndrome of the thigh following a gunshot injury that resulted in significant morbidity is presented. Early diagnosis of this uncommon condition requires a high index of suspicion in order to reduce morbidity and mortality. Timely diagnosis, emergency three-compartment decompression, prophylaxis against reperfusion syndrome and aggressive rehabilitation are necessary for a favourable outcome.

Granulomatous lobular mastitis. A case report and review of the literature

Granulomatous lobular mastitis is a rare, benign, inflammatory breast condition of unknown aetiology that can clinically mimic breast cancer. Awareness of this condition is important, as the appropriate specimens must be taken to confirm the diagnosis and to rule out an infectious aetiology. While surgical excision has been the traditional therapeutic modality, the most appropriate therapy seems to involve the use of corticosteroids, even in the case of recurrence.

Management of hepatic cysts by percutaneous drainage and instillation of tetracycline hydrochloride

This paper reports two cases of benign hepatic cysts successfully treated by the instillation of tetracycline hydrochloride. The patients presented with solitary large symptomatic hepatic cysts and underwent ultrasound guided needle aspiration followed by the instillation of tetracycline hydrochloride. The cyst size diminished without complication and the patients have remained symptom free. We review the treatment of this uncommon entity and propose that injection of tetracycline hydrochloride is an effective nonoperative treatment of symptomatic solitary hepatic cysts.