W Indian Med J
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During the period January 1994 to December 1999, a total of 395 patients--adults and children--underwent various types of open heart surgical (OHS) procedures. The age range of these patients was 10 days to 77 years. Most (43.5%) of these patients underwent valve replacement--first time and 'redo'--as a result of rheumatic heart disease of varying duration and severity. ⋯ However, the true incidence of NCs (gross and subtle) in the study group cannot be ascertained. A detailed, structured neurological and neuropsychiatric assessment, both pre- and post-operatively, is therefore needed to document the true incidence of this complication. There is also the need for public education, especially for those with valvular disease, in order to encourage changes in attitude and behaviour towards continued follow-up care and valve surgery, both first time and 'redo'.
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Atrial fibrillation and/or flutter is the most common and the most significant cardiac arrhythmia in the Caribbean. This study is an attempt to determine the echocardiographic findings in a current, consecutive series of Afro-Caribbean patients referred for evaluation of atrial fibrillation and flutter. Between May 1998 and June 2000, 50 patients (mean age 67 years, 58% male) had echocardiograms done. ⋯ Patients with lone atrial fibrillation were younger (mean 56 years) than those with valvular disease (mean 64 years), LV systolic dysfunction (mean 69 years) and those with LV hypertrophy (mean 72 years). Thus, LV hypertrophy, probably secondary to hypertension, is the most frequent echocardiographic finding, with LV dysfunction (such as seen in coronary artery disease) seen less often. Valvular disease and lone atrial fibrillation rates are similar to rates in developed countries.
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Review Case Reports
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.
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Comparative Study
Patterns of trauma injuries in rural versus urban Jamaica.
Trauma admissions to St Ann's Bay Hospital in rural Jamaica and The University Hospital of the West Indies (UHWI) in the capital city of Kingston are compared. Trauma accounted for 19% and 22% of surgical admissions to UHWI and the St Ann's Bay Hospital, respectively. Sixty-three per cent of trauma cases admitted to the St Ann's Bay Hospital and 56% to the UHWI were due to unintentional injuries (95% CI, -0.05, 0.19). ⋯ Intentional injuries accounted for 37% of cases in St Ann's Bay Hospital and 44% at UHWI (95% CI, -0.20, 0.04). The prevalence of firearm injuries was significantly higher at the UHWI than in St Ann's Bay Hospital, 55% and 18% respectively (95% CI, -0.15, -0.05). There was no significant difference in age and injury severity scores in the two hospitals but patients remained in hospital significantly longer at UHWI.
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A retrospective evaluation of the Computed Tomography (CT) findings in three hundred and forty-four patients with seizures, presenting over a one-year period, was carried out to determine the value of this examination in the assessment of these patients. Eighty-four per cent of patients had non-contrast studies only. Of the remaining patients, two had contrast studies only and the rest had both non-contrast and contrast studies. ⋯ There was a greater detection rate in patients with seizures secondary to trauma, cerebrovascular incidents, infection, metabolic causes and suspected tumours. Computed tomography continues to have a place in the evaluation of certain types of seizure patients. The routine use of intravenous contrast does not appear to be justifiable.