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This study reports the first 13 cases of biopsy-proven low rectal carcinoma treated by transanal electrocoagulation using a locally manufactured instrument. At the University Hospital of the West Indies, over a 16-year period, 9 patients were treated for cure, six of whom have no clinical evidence of recurrence for one to 12 years. Four cases who were offered this procedure for palliation defaulted after a single treatment. Transanal electrocoagulation provides an additional option for treating patients with small, mobile low rectal cancers, following careful screening for evidence of nodal or distant spread. The procedure can also be used in the local control of disease in patients with distant spread or in whom a major operation is not feasible (AU)

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This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.

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This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.(AU)

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A case of thoracic outlet syndrome (TOS) treated at the University Hospital of the West Indies, Jamaica is presented. The diagnosis, investigation and management of TOS are discussed.

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A case of thoracic outlet syndrome (TOS) treated at the University Hospital of the West Indies, Jamaica is presented. The diagnosis, investigation and management of TOS are discussed. (AU)

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A total colectomy and a mucosal proctectomy with ileo-anal anastomosis (c-mp-iaa) effectively removes all debilitating, potentially malignant colonic mucosa. Preservation of the anorectal sphincter predictably results in good to excellent anal continence with a low mortality and acceptable morbidity. Since 1983 at the University Hospital of the West Indies (U.H.W.I.), Jamaica, five (5) patients have undergone c-mp-iaa for colonic mucosal disease. All have good to excellent anal continence with an average of 2-6 continent, formed stools per day. There were no operative deaths. The five (5) cases are described and a plea is made for the earlier use of this definitive surgical procedure where indicated. (AU)

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Gallstone ileus is a rare cause of mechanical bowel obstruction. The attendant lack of awareness by the clinician will not only result in the diagnosis being made intraoperatively but will also affect the adequacy of the preoperative preparation of these ill patients. These patients are often elderly, septic and have significant concomitant medical illnesses. Recently two patients with gallstone ileus were managed with enterolithotomy and primary repair of the cholecyst-duodenal fistula at the University Hospital of the West Indies, Jamaica. Their clinical presentations and progress are described along with a review of the classical clinical course, radiological features, and operative choices available. (AU)

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The modified Whipple gastro-pancreatico-duodenectomy has been the time-honoured surgical management of duodeno-pancreatic disease for the past five decades. A pylorus-sparing modification of this operation has become popular due to its low morbidity and the relative lack of the long-term nutritional sequelae usually associated with the more radical procedure. We report five cases with a proximal pancreatico-duodenectomy in whom the stomach, pylorus abd first 2 cm of duodenum were preserved. The indcations for the procedure were varied and included duodeno-pancreatic haemangioma (1), duodeno-pancreato-codochal trauma (1), chronic pancreatitis (1), papillary cystic tumour of the pancreas (1), and ampullary adenocarcinoma (1). All cases had gastrostomy decompression and post-operative enteral nutrition. Two patients required enteral feeding for twelve days, the other three settled rapidly and were discharged from hospital within ten days. There were no perioperative deaths or significant long-term morbidity. Most patients regained and maintained their pre-illness body weight within the first year of follow-up. We advocate the use of a pylorus-sparing pancreatico-duodenectomy in disease requiring duodeno-pancreatectomy inclusive of periampullary malignancies (AU)

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The pathological records of appendicectomy specimens from patients with suspected acute appendicitis at the University Hospital of the West Indies during the 5-year period 1984-1988 were studied. The numbers of cases, their ages, sex and seasonal incidence were similar to those of other studies. The over-all false positive diagnosis rate was 25 percent (16 percent in males, 38 percent in females). The main diagnostic difficulty was in young females in whom surgery for suspected appendicitis often proved unnecessary. (AU)

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Preservation of the ano-rectal spinchter and lower rectal muscle cuff following total colectomy and a mucosal protectomy with ileo-anal anastomosis (CMP - IAA) effectively removes all the debilitating, potentially malignant colonic mucosa and results in good to excellent continence. Since 1983 at U.H.W.I., Mona, five (5) patients have undergone CMP - IAA for colonic mucosal dysplasia and multicentric adenocarcinoma (1), familial polyposis coli (1), juvenile polyposis coli (1) and ulcerative colitis (2). Four out of five have had clousure of their temporary diverting ileostomy and all have good to excellent anal continence, with an average of 2 - 6 stools/day. There were no deaths and an unremarkable post-operative course was noted in all except one patient with over a 20-year history of steriod-controlled ulcerative colitis. She had a prolonged stormy post-operative course, rectal cuff abscess and resulting ileo-anal stricturing. Not withstanding this, she has good anal continence, but requires digital dilation. This initial experience of the U.H.W.I. group compares favourably with over 2,500 cases in the current literature and establishes CMP - IAA as the procedure of choice in this group of young, active patients (AU)

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Papillary cystic tumor is an uncommon neoplasm of the pancreas which has only been described recently. This report describes five such cases seen at the University Hospital of the West Indies (UHWI). The clinico-pathological features were typical in all these cases. The literature of this condition is also reviewed. (AU)

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A prospective study if 176 fine needle aspiration biopsy (FNAB) in 172 patients was carried out to assess the accuracy of FNAB in diagnosing breast cancer at the University Hospital of the West Indies. The results showed 99 per cent and 97 per cent accuracy and sensitivity rates, respectively. There were no false positives and a one per cent false negative rate. FNAB provides a rapid, safe and cheap method of accurately diagnosing breast cancer (AU)

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Two patients with high voltage electrical injury involving the trunk are presented. Both injuries were complicated by visceral damage; and one patient died from sepsis secondary to bowel perforation. The rarity of this complication is examined in light of the pathophysiology of electrical injury; and its management is discussed with reference to previously published reports on this condition. (AM)

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Benign biliary strictures are rare. Their management represents a challenge to the practising surgeon. Six cases seen at the University Hospital of the West Indies are reviewed. Early recognition and management by an experienced surgeon will improve prognosis (AU)

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One Hundred and One (101) patients with abdominal aortic aneurysms seen during the 18-year period January, 1956 to December, 1982, were reviewed. Resection was performed in 67, and 50 of these were non-ruptured. Compared to other reported studies, there was little difference in age group, patient population or mode of presentation. There were very few small and asymptomatic aneurysms, and large aneurysms were relatively common. These differences were interpreted to indicate a more advanced stage of aneurysmal disease in our patients. The mortality in the present series for resection of ruptured aneurysms remains above 50 percent, and the mortality for resection of non-ruptured cases is still higher than that reported elsewhere. The two most significant risk factors for elective resection in our patients seem to be advanced age and the presence of pre-existing coronary artery disease (AU)

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A two-year review of the diving accidents seen and treated at the Discovery Bay Marine Laboratory Jamaica since November 1981 was analysed for factors affecting the presentation and ultimate outcome of the accident. This recompression facility has been maintained by the University of the West Indies primarily as a safety measure for the marine researchers at this centre. It has a 6-inch diameter, double-lock hyperbaric chamber suitable for full recompression therapy, and is under the supervision of a full-time diving officer and chamber operator. The chamber accepts community accidents on a voluntary basis. During the 24-month period under review, 26 dive-related incidents were seen at the centre. Foreigners accounted for 15/26 with a 5/15 permanent neurological deficit noted at the end of treatment. One patient had severe permanent cerebral damage. This group contained the two fatalities noted in the series. There were 9/26 Jamaicans, with 3/9 demonstrating less than 15 percent permanent neurological injury. The official users of the centre had only two incidents, both of which had full recovery. This was in spite of the frequency of multiple daily dives, averaging 5 - 10 dives per day. It demonstrates the good training practices insisted on, and the readily accessible recompression facility. Many case histories reviewed demonstrated not only diver-abuse of the accepted requirements of compressed air diving, but also a serious lack of appreciation of the dangerous sequelae of decompression sickness and air embolism, by the medical personnel involved. It was in the interest of the latter, both the general practitioner and the Regional Hospitals in the tourist-oriented Caribbean Islands, that this report was prepared. A recently handicapped, young, litigation minded tourist must become a stark reality for anyone practising in such areas (AU)

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Eight hundred twenty-nine patients were monitored for nosocomial surgical infections from January to December 1980 at the University Hospital of the West Indies. Two hundred twenty-five patients (27 percent) had 189 post-operative infections (POWI) and 295 other nosocomial infections with an average of 2.1 infections per infected patients. The incidence of POWI was 22.8 percent, varying from 7.3 percent in clean to 82.2 percent in infected wounds. The most common organisms isolated were gram-negative bacilli and Staphylococcus aureus. The most frequent nosocomial infection other than was urinary tract infection (27.8 percent). A statistically signifcant number of urinary tract infections and septicemias were associated with the use of medical devices such as indwelling urethral catheters and central venous pressure lines (p < 0.001). Septicemia was frequently associated with operations on the lower gastrointestinal and hepatobiliary tracts ( p < 0.001). The postoperative stay of an infected patient was prolonged by an average of 18 days. The total excess cost of hospitalization for the infected patients was U.S. $170,000 (AU).

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