Paediatric neurosurgery in Trinidad and Tobago - abstract

Neurosurgery in childhood is a distinct branch of neurosurgery. All cases admitted to the paediatric section of the neurosurgical unit in the 5 years from July 1980 to June 1985 were studied retrospectively, to determine the disease pattern and outcome. There were 260 cases with even annual and sex distribution, 40 percent in their first year, 20 percent total newborn, and the rest below the age of 12 years. Eighteen were from other Caribbean territories. There were 214 cranial diagnosis, distributed as congenital, 72; head injury, 76 infection, 12; vascular, 4; tumours, 20, and other, 30. Significant were hydrocephalus, 51; encephalocele, 8; craniosynostosis, 6; depressed skull fracture, 25 acute subdural haematoma, 3; brain stem injury, 8, and cerebral abscess, 3. The tumours were brain stem astrocytoma, 6; cerebral astrocytoma, 5 medulloblastoma, 4; craniopharyngioma, 2, and one each of cerebellar astrocytoma, pineal tumour and ependymoma. There were 63 spinal diagnosis - congenital, 52; injury, 4; tumours, 3 and other, 4. Significant were mylomeningocele, 40, and, in tumours, one each of cervical meningioma, chondrosarcoma and neurofibroma. There were 160 surgical procedures - congenital, 92: trauma, 37:infection, 8: vascular, 2: tumours, 19, and others, 2. The most frequent procedures were ventriculo-atrial shunt, 27: ventriculo-peritoneal shunt, 25; shunt revisions, 36; encephalocele repairs, 8; craniosynostosis, 5; release, 3 craniotomies for acute subdural haematoma, 21 fracture elevations, 10 exploratory burr holes, 3 cerebral abscess evacuation, and for tumours, 4 craniotomies, 4 posterior fossa explorations and 7 shunts. In the spinal group, there were 33 myelomeningocele repairs and a cervical meningioma, chondrosarcoma and neurofibroma were removed. Ther were 33 deaths; 21 of these had had surgical procedures. In the total group, 10 were related to congenital defects, 12 were severe head injury, 2 meningitis, 2 ruptured intra-cranial bascular lesions and 6 tumours. The following pertinent factors emerged: neural tube defects were noted in the East-Indian in the East-West corridor and Changuanas and in the Afro-Trinidadian in the Belmont-Laventille area. The ventriculoatrial shunt seemed preferable to ventriculo-peritoneal, and the use of 2 separate shunt systems in recurrently malfunctioning shunts was a successful new approach. Head injuries were common and the survival rate unexpectedly good. Spinal fractures were uncommon. Infection had a good prognosis but paediatric brain tumours presented the same dismal picture as it does worldwide (AU)

Aspergillosis of the paranasal sinuses

We present a case of aspergilosis of the paranasal sinuses in a female patient, who is otherwise in good health (AU)

Neural tube defects in Trinidad - abstract

All cases of neural tube defects (NTD) at the Port-of-Spain General and Mount Hope Hospital for Women from June 1980 to July 1983 were studied retrospectively with respect to sex distribution, ethnic group, social class of parents, area of residence, birth weight, birth order, maternal age, associated congenital abnormalities, family history, annual incidence and other factors. There were 71 NTD with no sex predominance. Twenty-six were of African descent and 38 of East Indian descent and 7 of mixed ethnic origin. The incidence in Trinidad of NTD per thousand total births 1.52 overall, 1.40 in the African and 2.05 in the East Indian, was much lower than in countries of similar ethnic groups - 2.74 Pretoria, South Africa in the Bantu and 3.75 in Bombay, India. In Trinidad, the incidence of anencephalus was particularly low in the African. The incidence of hydrocephalus, hydrocephalus with spina bifida, occiptal meningocele and other neural tube defects was about the same in both ethnic groups, while spina bifida incidence was relatively higher in the East Indian. Those of African descent were clustered in the Belmont-Laventille-Morvant area, while those of East Indian descent were clustered in the Chaguanas and in the San Juan to Tunapuna area, and the occurence in these areas was disproportionately high and not totally explained by population distribution. Other positive findings were low birth weight and being first-born with anencephalus, and social classes 4 and 5 in parents of patients with NTD. This study shows a low Trinidad incidence of NTD, differing ethnic incidence and distribution, and suggests a multifcatorial aetiology (AU)

Primary neoplasms of the central nervous system in Trinidad

The incidence of primary neoplasms of the central nervous system in Trinidad is less than 1 case per 100,000 population per year. There is no significant difference in the sex and age distribution of the cases, but a definite racial difference is seen in the frequency of different CNS neoplasms (AU)

Pattern of head injuries in road traffic accidents in Trinidad

A study of head injuries occurring in road traffic accidents and presenting at the Port-of-Spain General Hospital in Trinidad has been carried out. The hospital serves a population of about half a million persons. An average of 69 head injuries were admitted each month in 1972. In a study of the incidence in the months of December from 1968 to 1972, there has been a gradual rise from 54 cases in 1968 to 71 cases in 1972, with a sex ratio of 2 males 1 females. Some 40 percent of cases less than 10 years of age, and another 20 percent are between the ages of 10-20 years; only 5 percent are over the age of 50 years. Head injuries from road traffic accidents constitute about 45 percent of all head injuries admitted to the hospital. The mortality from head injuries is some 3 percent, and figures are presented to show that the severity of head injuries over the years has increased, and are requiring unneccessary complex therpeutic measures, including operative intervention (AU)

Spontaneous organic hypoglycaemia

Three cases encountered in the past five years in Trinidad were presented. All were females, aged 15, 30 and 66 years. Two cases presented with convulsions. All three patients underwent laparotomy and in only one was any pathological change noted: an anaplastic carcinoma of the pancreas with nodal metastases (AU)