Shamir O. Cawich

Brachial Artery Injury Accompanying Closed Elbow Dislocations

Highlights • Brachial artery injuries after closed shoulder dislocations are uncommon.• A high index of suspicion should be maintained in order to make the diagnosis early.• Exploration with excision of the injured segment and reverse vein interposition grafting is the treatment of choice in these cases.

Idiopathic thyroid abscess

INTRODUCTION Thyroid abscesses are uncommon because the gland is relatively resistant to developing infection due to its rich blood supply, well-developed capsule and high iodine content. However, clinicians must be aware of this differential to make an early diagnosis. PRESENTATION OF CASE We present the case of a patient who required urgent operative resection as definitive treatment for a thyroid abscess secondary to infection with Staphylococcus aureus. DISCUSSION Although this is rare, a thyroid abscess left untreated can lead to serious morbidity. Therefore, clinicians must be aware of the presenting features and therapeutic options. CONCLUSION Thyroid abscess is an uncommon diagnosis but can lead to significant morbidity. Therefore clinicians must be aware of the diagnosis in order to institute early aggressive management.

Vascular Supply to the Liver: A Report of a Rare Arterial Variant

In the classic description of hepatic arterial supply, the common hepatic artery originates from the coeliac trunk. However, there are numerous variations to this classic pattern. We report a rare variant pattern of hepatic arterial supply and discuss the clinical significance of this variation.

Declaration of a state of emergency in Trinidad and Tobago: effect on the trauma admissions at the national referral trauma centre

OBJECTIVE To determine the effect of a State of Emergency (SOE) on penetrating injuries at the main trauma center in Trinidad and Tobago. METHODS Emergency room registers were accessed in order to identify all patients treated for penetrating injuries from July 1, 2010 through December 30, 2012. This study period was chosen to include injuries one year before and one year after the SOE that spanned from August 21, 2011 to December 5, 2011. Data were analyzed using SPSS version 19 and a P value<.05 was considered statistically significant. RESULTS There were 1,067 patients treated for penetrating injuries. There were significantly more injuries from gunshots compared to stab wounds (64.7% vs 35.3%; P<.001), and this pattern was maintained during the SOE (54.7% vs 45.3%; P=.37). There was a significant fall in mean monthly admissions for penetrating trauma during the SOE when compared to the 12-month period before its imposition (17.7, SD=4.0 vs 38.9, SD=12.3; CI, 5.6-36.8; P=.0108). One year later, mean monthly admissions for penetrating trauma were similar to those during the SOE (22.7, SD=2.1 vs 17.6, SD=4.0; CI, -2.3-12.3; P=.1295). The incidence of gunshot wounds remained low and stab wounds increased. CONCLUSION This study has demonstrated that there was a reduction in the incidence of penetrating trauma at the national trauma center after the SOE, with a shift from gunshot to stab wounds.

The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report

Highlights • Primary hepatic angiosarcomas are rare in the Western world.• At the time of diagnosis, primary hepatic angiosarcomas are often locally advanced.• Surgeons should be aggressive in the pursuit of complete resections because this is the only treatment modality that has been shown to have a survival advantage.• In selected cases, the hanging manoeuver may be employed to allow controlled parenchymal transection and minimal bleeding.• Hepatobiliary surgeons should keep the hanging manoeuver in their armamentarium when performing complex liver resections for locally advanced angiosarcomas.

Is emergent laparoscopic cholecystectomy for acute cholecystitis safe in a low volume resource poor setting

BACKGROUND The outcomes of emergent laparoscopic cholecystectomy (LC) for acute cholecystitis have not been documented in the low-volume, resource-poor Caribbean setting. SETTINGS AND DESIGN This study was carried out in a low-resource setting across three islands in the Anglophone Caribbean. METHODS AND MATERIALS The records of all consecutive patients who had emergency LC for acute cholecystitis over 82 months were examined. The data were extracted and analysed using SPSS version 14. RESULTS There were 74 patients with acute cholecystitis at a mean age of 45 (SD 11.8) years. The mean duration of operation was 99 (SD 45) min. There were 3 (4.1%) conversions and 6 (8.1%) complications. No bile duct injuries or deaths were recorded. There was more morbidity in patients with complicated disease, longer mean operation times and longer mean intervals between admission and operation. CONCLUSIONS Emergent LC for acute cholecystitis is effective and safe in a low-volume setting in the Caribbean. However, the operations are technically demanding and should be performed by trained laparoscopic surgeons.

Inguinal Hernia and Airport Scanners: An Emerging Indication for Repair?

The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency.

Clinicopathologic features of solid pseudopapillary pancreatic neoplasms in an Eastern Caribbean population

Pancreatic solid pseudopapillary neoplasms (SPNs) are uncommon lesions across the globe. Their incidence is unknown in the Caribbean. This retrospective study sought to document the clinicopathologic features of pancreatic SPNs in an Eastern Caribbean population. We examined data from the hospital records of all patients with SPN in Trinidad and Tobago, finding 11 cases over five years, equating to an incidence of 0.17 cases per 100,000 population per year. The lesions occurred in girls and young women at a mean age of 25 years, with a propensity for those of Afro-Caribbean descent. Poor prognostic factors (histologic invasion of the capsule, lymphovascular invasion, spindle cells, anaplastic cells and/or excessive mitotic figures) were present in 82% at the time of diagnosis. These tumours are uncommon in our population, and since most have poor prognostic features at diagnosis, we advocate an aggressive surgical approach.

Mature Cystic Teratoma Hiding in the Retroperitoneum of an Adult

We report a rare case of a mature cystic teratoma found in the retroperitoneum of a 28-year-old woman with vague symptomatology. We review the radiologic and pathologic features of this rare lesion.

CT guided appendicectomy incision: A prospective case series

Highlights • Mc Burney’s point often does not correspond to the base of the appendix.• Blindly making an incision at Mc Burney’s point can often be challenging to locate the Appendix as the position of the base of Appendix very variable and may require unnecessary extension of the wound.• CT scan effectively localizes the base of the Appendix and therefore can guide more accurate placement of the incision.• Incisions planned based on CT scan can facilitate localization of the Appendix and may also minimize incision length (as wound extension is often required for unguided incision).• The authors of this paper strongly recommend a CT guided appendicectomy incision for open appendicectomy.