G Wharfe

Induction of labour with intravaginal misoprostol versus dinoprostone in intrauterine death: A retrospective study

SummarySummaryBetween March 1992 and November 1994, 48 patients with intrauterine death had labour induced, 36 with the prostaglandin analogue misoprostol and 12 with the prostaglandin dinoprostone. Both were used as a single dose in 24 hours intravaginally. The patients were all of low parity and all but one were in the third trimester. Of those getting misoprostol, 92 per cent, and of those getting dinoprostone, 67 per cent, went into spontaneous labour. Eighty-one per cent of those getting misoprostol and 67 per cent of those getting dinoprostone delivered within 24 hours without the need for further prostaglandin or oxytocin, a difference that was not significant. No differences were found in other outcome variables such as diagnosis or induction to delivery time or need for oxytocin, between the two groups. Only one maternal medical complication occurred, chorioamnionitis in a patient who had misoprostol, and in whom labour was delayed 6 days.

Bone mineral density in Jamaican black women after hysterectomy and bilateral oophorectomy: an observational study

OBJECTIVE To see if black Jamaican postmenopausal women who had hysterectomy were at increased risk of osteoporosis. To assess the risk of osteoporosis in hysterectomized Jamaican postmenopausal patients. METHOD We reviewed 809 women (403 hysterectomized and 406 controls) for cardiovascular disease risk. We did a demographic history and examination looking at blood pressure, waist hip ratio and body mass index and investigations done included fasting blood glucose and total and high density lipoprotein (HDL) cholesterol. We also measured bone density at the heel in all women using the Achilles ultrasound bone densitometer looking at T-score and Z-score. RESULTS There was a significant association of hysterectomy status and bone mineral density (BMD) status with a smaller than expected proportion of women with osteoporosis in the hysterectomy group (χ2 = 18.4; p = 0.001). The mean T-score was significantly higher in the hysterectomized women, adjusting for age, waist circumference and sociodemographic factors. The relationship between the various predictors and BMD was explored by stepwise regression modelling. The factors that were significantly related to low BMD were hysterectomy status, age, waist circumference and being employed. CONCLUSION Hysterectomy was not found to be a significant risk factor for osteoporosis. The osteoporosis risk among menopausal women in Jamaica appears to be due to other risk factors which probably existed prior to the operation.

Abstract P3-08-06: Demographics of breast cancer in a cohort of Afro-Caribbean women

Objectives: In Latin America and the Caribbean, non – communicable chronic diseases are now the leading cause of premature mortality. The incidence of cancer has increased in the region as a result of population aging and growth but also as more people adopt lifestyle choices like smoking, physical inactivity, and ‘‘westernized’’ diets. In women, fertility factors such as decreased parity, earlier onset of menses and later age at time of first pregnancy are known epidemiologically to increase incidence of hereditary and sporadic breast cancer. Recently there has also been a strong link to a genetic etiology of the breast and ovarian cancer in the Bahamas (27% in unselected breast cancer cases). A study was designed to address the prevalence and spectrum of BRCA1 and BRCA2 mutations in the Afro-Caribbean population. Methods: Demographic and clinical pathologic data was collected from 347 women of Afro-Caribbean decent. The cohort included women with breast cancer from the following countries: the Cayman Islands, Jamaica, Barbados, Dominica, Trinidad and Haiti. Summary statistics and t-tests and ANOVA were used to analyze population characteristics. A Bahamian mutation panel was created and detailed analyses of samples are ongoing. Results: The mean age of onset in the cohort is 48.1 yrs with a mean BMI of 27.7. 70% of breast cancer cases ER+ (n=241 informative cases) and in Jamaica 27% (n=105) of breast cancer cases were Her2+. 67.8% cases were diagnosed at stages II/III (n=90). TAH-BSO delayed invasive breast cancer from 48 to 53 years, p=0.005. Parity was a statistically significant factor (p Conclusions: This population-based study provides an insight into pattern of risk factors – both genetic and environmental of breast cancer incidence and subtype across the Caribbean. In conclusion 1) genetic causes of breast cancer appear rare outside of the Bahamas, 2) fertility factors appear important in the development of breast cancer, 3) TAH-BSO is common as both a form of contraception and because of the high incidence of fibroids in the Caribbean and it may be protective, 4) BMI may impact on breast cancer development and 5) screening mammography is rare and the vast majority of mammography performed is diagnostic in nature. Citation Format: Sophia HL George, Talia Donenberg, Mohammed Akbari, Cheryl Alexis, Gillian Wharfe, Sook Yin, Hedda Dyer, Theodore Turnquest, Vincent DeGennaro, Steven Narod, Judith Hurley. Demographics of breast cancer in a cohort of Afro-Caribbean women [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-08-06.

Blood use in neurosurgical cases at the University Hospital of the West Indies

OBJECTIVE Many neurosurgical cases are done without the need for blood transfusion, yet blood is unnecessarily cross-matched, resulting in wasted resources. This study was undertaken to document and compare the number of units of blood components requested, cross-matched and transfused in neurosurgical cases at the University Hospital of the West Indies (UHWI). METHODS A prospective, observational study was undertaken over one year. Data collected for each patient included demographic information, relevant perioperative data, and blood banking data including blood components requested, cross-matched and transfused. Data were analysed using SPSS version 16. RESULTS Data were analysed on 152 patients, 71 females (46.7%) and 81 males (53.3%). The mean age was 48.7 ± 19.6 years and 100 of the procedures were done electively (65.8%). Blood components were ordered in 114 (75%) cases, red cells more commonly in 113 (74.3%) patients, and plasma in 19 (12.5%) patients. Overall, 20 patients (13.2%) were transfused. Most patients (90.9%) needed one to two units of blood. Of the 236 units of blood components that were cross-matched or prepared, only 62 were transfused. The cross-match/preparation to transfusion ratio (CTR/PTR) was 6.00 for red cells and 1.31 for plasma. Preoperative haemoglobin ≤ 10.0 g/dL (p = 0.001), estimated blood loss of ≥ 1 litre (p < 0.001), higher American Society of Anesthesiologists (ASA) physical status score (p < 0.03) and a resident as lead surgeon (p < 0.05), were significant predictors of blood transfusion. CONCLUSION The transfusion rate was low with a high cross-match to transfusion ratio, suggesting that less cross-matching is needed. A new approach to blood ordering for neurosurgical cases is recommended.

A case of pseudotumour in a haemophiliac

INTRODUCTION Pseudotumour is a rare complication of severe haemophilia seen in only 1–2% of persons with the severe form of the disease (1, 2). These lesions were first described by Starker in 1918 as a slow progressive subperiosteal haemorrhage. These lesions may progress relentlessly if left untreated, resulting in compression and pressure necrosis of adjacent structures (1, 3–5). Due to the uncommon occurrence of this lesion, there are no standardized protocols for management. Treatment usually consists of the early and appropriate replacement of factor VIII, and surgical excision of the lesion to prevent further complications if it is progressively enlarging (6). The case of a young boy with severe haemophilia A who presented to the Orthopaedic Department with a pseudotumour of the left tibia is presented with a review of the clinical and radiological findings.