Single-incision laparoscopic splenectomy.

Single-incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. We present a case of SILS splenectomy performed with conventional laparoscopic instruments in a 7-month-old boy with the diagnosis of multiple splenic abscesses. A 3-cm umbilical incision was used for the placement of two (5 mm) trocars and one 10-mm videoscope (30°). Conventional laparoscopic dissector and grasper were the main tools during surgical procedure. Spleen was removed through the umbilical incision. Although procedures like aingle-incision cholecystectomy have been reported, to the best of our knowledge this is the first report of SILS splenectomy using conventional laparoscopic instruments reported from India and is perhaps the first in an infant in the world literature.

Infection in a multidisciplinary intensive care unit at the University Hospital of the West Indies

The records of 1,252 patients were reviewed to determine the incidence of infection, mortality and associated risk factors in our multi-disciplinary intensive care unit (MD-ICU) during the period 1977 to 1982. The infection rate and the mortality rate were 24 percent and 22 percent respectively. The mortality rate in the infected group was 25 percent. The infection rate was higher in the intra-abdominal and trauma group as compared to the cardio-thoracic group (P<0.05). The incidence of ICU-acquired respiratory tract infection (41 percent), wound infection (17 percent) and urinary tract infection (15 percent) was significantly different from non-ICU acquired infections (P<0.05). The commonest site of infection was the respiratory tract (37 percent). The incidence of infection was directly related to the duration of medical devices left in situ and the length of stay in the unit (more than seven days) (AU)

Post-cardiac arrest survival of patients following admission to the intensive care unit - abstract

A retrospective study of patients admitted to the Intensibe Care Unit (ICU) at the Uiversity Hospital of the West Indies following a cardiac arrest was undertaken to determine the early and late survival rates. Patient data was collected on forms and inserted in a patient data-base (ICU-DATA) utilising a SWTPC micro-computer system. Pertinent data was retrieved and analysed using the report-writer and sort/merge software programmes respectively. During the 2-year period (1/1/81 to 31/12/82), 51 patient were admitted to the ICU following successful resuscitation of cardiac arrest. There were 32 males and 19 females and their ages ranged from 1 day to 78 years (mean 38.3 years). The secondary diagnosis was as follows:- cardiovascular (10), postoperative (8), central nervous system (7), respiratory (6), diabetes (4), renal failure (3), shock (3), anaemia (2), systemic lupus (1), multiple myeloma (1), not recorded (6). Forty (40) patients, i.e 78.4 per cent, died in the ICU. Their duration of stay ranged from 1 hour to 8 days (mean 1.2). The remaining 11 patients who were discharged from the ICU, 5 died on the convalescent wards and 1 at home. Of the remaining 5 survivors, 2 were lost to follow-up. The other 3 patients are doing well. Hence the overall death rate was 90.1 per cent (AU)