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The nutcracker phenomenon, also known as left renal vein entrapment, occurs when there is extrinsic compression of the left renal vein, most often between the abdominal aorta and the superior mesenteric artery. Nutcracker syndrome refers to the constellation of clinical symptoms that may arise from the nutcracker phenomenon, typically inclusive of haematuria, flank/pelvic pain, orthostatic proteinuria and (in male patients) varicocele. We provide a short review of the nutcracker syndrome including various diagnostic and therapeutic modalities. We utilise our own experience with a patient as a case study and highlight the modern management option of endovascular stenting.
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Objectives: To establish normative Hand Grip Strength (HGS) data for Trinidad and Tobago and to assess factors that may influence hand grip strength within this population. Design and Methodology: A cross sectional study of participants between the ages of 18-80 years was conducted at five distinct geographic regions in Trinidad and Tobago. Demographic data was collected including hand dominance. HGS was measured using a Jamar dynamometer. Descriptive statistics were performed for all direct measurements and Pearson's correlation coefficient used to analyze the relationship between variables. All statistical analysis was performed using the Statistical Package for Social Sciences (SPSS v20) p-value < 0.05 was considered significant. Results: A total of 1354 participants took part in the study, with 121 exclusions leaving 1233 for analysis. There were 561 males (45.5%) and 672 females (54.5%). The mean age of the participants was 42.5 years (SD +/-15.5) and mean body mass index (kg/m2) 27.3 (SD +/- 6.0). The overall mean HGS for our sample was 28.4 kgs. (SD +/- 2.9) with males having a higher overall HGS compared with females. Conclusions: This study presents previously unreported normative data on HGS in a Trinidad and Tobago population. This data will allow for a more objective evaluation of hand function in patients following injury and has implications for the assessment of disability in workmen's compensation.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Força da Mão , Trinidad e TobagoRESUMO
Objectives: To investigate the epidemiology, management and predictors of mortality in severe sepsis. Design and Methodology: Prospective observational study in 4 Trinidadian Intensive Care Units (ICU) over a one year period August 2017-August 2018. Physiologic and treatment data was collected on admission to ICU and patients were followed up until ICU discharge and then at 28 days to determine mortality. Results: 163 patients fit the criteria for severe sepsis and were enrolled. Twenty-eight day and ICU mortality rate were 42% (68) and 34 % (56) respectively. Case distribution by the various hospitals were San Fernando General Hospital 62% (101), Port of Spain General Hospital 16% (26), Eric Williams Medical Sciences Complex 12.3% (20) and Sangre Grande Hospital 9.8% (16). The most common source of sepsis was pulmonary (54%) followed by abdominal (17%) and urological sepsis (14%). Acute Kidney Injury (AKI) was present in 71% (115) patients and 43% (46) of patients with stage 2 and above AKI received Renal Replacement Therapy (RRT) in the ICU. In the regression model, the only factors that were found to predict both 28 day and ICU mortality were stage 2 AKI [OR 6.2 (95% CI 1.7- 23.1, p = .007)], stage 3 AKI [OR 7.2 (95% CI, 2.1-24.0, p=.001)] , mean arterial pressure of < 60mmHg in the first 24 hours [OR 10.8 (95% CI 1.7-68.1, p= .001)], presence of either moderate-severe Acute Respiratory Distress Syndrome [OR 4.1 (95% CI 1.8 9.2, p = .002)] and Acute Physiology, Age, Chronic Health Evaluation (APACHE) II score [OR 1.08 (95% CI, 1.0-1.2, p=.039)]. Conclusion: Severe sepsis is associated with a high hospital mortality rate and this sepsis burden varies according to region. Limited access to RRT remains a problem in certain centers.
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Humanos , Sepse , Choque Séptico , Trinidad e Tobago , EpidemiologiaRESUMO
OBJECTIVE: To describe the characteristic presentation of exertional leg pain in athletes and to discuss the diagnostic options and surgical management of exertional anterior compartment syndrome of the leg in this group of patients. METHODS: Data from a series of athletes presenting with exertional leg pain were analysed and categorized according to aetiology. RESULTS: Sixty-six athletes presenting with exertional leg pain in 102 limbs were analysed. Sixteen patients in a first group of 20 patients with a provisional diagnosis of exertional anterior compartment syndrome of the leg underwent a closed fasciotomy with complete resolution of symptoms. A second group of 42 patients were diagnosed as medial tibial stress syndrome and a third group of four patients had confirmed stress fracture of the tibia. CONCLUSION: Exertional leg pain is a common presenting complaint of athletes to sports physicians and physiotherapists. Careful analysis can lead to an accurate diagnosis and commencement of effective treatment. Exertional anterior compartment syndrome can be successfully treated utilizing a closed fasciotomy with a rapid return to sport.
OBJETIVO: Describir las manifestaciones características del dolor en la pierna que presentan los atletas, y discutir las opciones de diagnósticos y tratamiento quirúrgico del síndrome compartimental de la pierna en este grupo de pacientes. MÉTODOS: Los datos de una serie de atletas con dolor en la pierna debido al esfuerzo excesivo en los ejercicios, fueron analizados y categorizados según la etiología. RESULTADOS: Sesenta y seis atletas con dolor de piernas debido al esfuerzo excesivo en 102 miembros fueron analizados. Dieciséis pacientes en un primer grupo de 20 pacientes con un diagnóstico provisional de síndrome compartimental anterior de la pierna por esfuerzo experimentaron fasciotomía cerrada con resolución completa de los síntomas. Un segundo grupo de 42 pacientes fueron diagnosticados con síndrome de estrés medial de la tibia, y a un tercer grupo de cuatro pacientes se le confirmó fractura por estrés o sobrecarga de la tibia. CONCLUSIÓN: El dolor de la pierna por esfuerzo en los ejercicios es una queja común con las que los acuden a los médicos y fisioterapeutas de la medicina deportiva. Un análisis cuidadoso puede conducir a un diagnóstico preciso y al comienzo de un tratamiento eficaz. El síndrome compartimental anterior por esfuerzo puede tratarse con éxito utilizando una fasciotomía cerrada que permita un rápido retorno a la actividad deportiva.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Traumatismos em Atletas , Síndrome do Compartimento Anterior/cirurgia , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/terapia , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/terapia , Esforço Físico , Fasciotomia , Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/etiologiaRESUMO
OBJECTIVE: To describe the characteristic presentation of exertional leg pain in athletes and to discuss the diagnostic options and surgical management of exertional anterior compartment syndrome of the leg in this group of patients. METHODS: Data from a series of athletes presenting with exertional leg pain were analysed and categorized according to aetiology. RESULTS: Sixty-six athletes presenting with exertional leg pain in 102 limbs were analysed. Sixteen patients in a first group of 20 patients with a provisional diagnosis of exertional anterior compartment syndrome of the leg underwent a closed fasciotomy with complete resolution of symptoms. A second group of 42 patients were diagnosed as medial tibial stress syndrome and a third group of four patients had confirmed stress fracture of the tibia. CONCLUSION: Exertional leg pain is a common presenting complaint of athletes to sports physicians and physiotherapists. Careful analysis can lead to an accurate diagnosis and commencement of effective treatment. Exertional anterior compartment syndrome can be successfully treated utilizing a closed fasciotomy with a rapid return to sport.
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Síndrome do Compartimento Anterior/cirurgia , Traumatismos em Atletas , Adolescente , Adulto , Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/etiologia , Fasciotomia , Feminino , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/terapia , Humanos , Masculino , Esforço Físico , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/terapia , Adulto JovemRESUMO
The Monteggia fracture dislocation and Galeazzi fracture dislocation are well recognized in isolation. The incidence of both of these fractures in the same forearm is rare. Only two other cases have been reported. This case report highlights the importance of early diagnosis and treatment of this combined fracture in a multiple trauma patient.
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Criança , Humanos , Fratura de Monteggia , Fraturas da Ulna/classificação , Fraturas da Ulna/complicações , Fraturas da Ulna/fisiopatologia , Traumatismos do Antebraço/complicações , Traumatismos do Antebraço/etiologiaRESUMO
The role of autologous stem cell transplantation (AuSCT) in older multiple myeloma patients is unclear. Using data from the Autologous Blood and Marrow Transplant Registry, we compared the outcome of 110 patients >/=the age of 60 (median 63; range 60-73) years, undergoing AuSCT with that of 382 patients <60 (median 52; range 30-59) years. The two groups were similar except that older patients had a higher beta(2)-microglobulin level at diagnosis (P=0.016) and fewer had lytic lesions (P=0.007). Day 100 mortality was 6% (95% confidence interval 4-9) and 1-year treatment-related mortality (TRM) was 9% (6-13) in patients <60 years, compared with 5% (2-10) and 8% (4-14), respectively, in patients >/=60 years. The relapse rate, progression-free survival (PFS) and overall survival (OS) in the two groups were also similar. Multivariate analysis of all patients identified only an interval from diagnosis to AuSCT >12 months and the use of two prior chemotherapy regimens within 6 months of AuSCT as adverse prognostic factors. Our results indicate that AuSCT can be safely performed in selected older patients: the best results were observed in patients undergoing AuSCT relatively early in their disease course.
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Mieloma Múltiplo/terapia , Transplante de Células-Tronco de Sangue Periférico , Adulto , Fatores Etários , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Tábuas de Vida , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , América do Norte , Osteólise/etiologia , Transplante de Células-Tronco de Sangue Periférico/mortalidade , Transplante de Células-Tronco de Sangue Periférico/estatística & dados numéricos , Sistema de Registros , Estudos Retrospectivos , América do Sul , Análise de Sobrevida , Condicionamento Pré-Transplante , Transplante Autólogo , Resultado do TratamentoRESUMO
OBJECTIVE: To report the experience in one centre of the efficacy and safety of open mini-access ureterolithotomy (MAU) and to discuss relevant current indications. PATIENTS AND METHODS: MAU was undertaken in 112 patients (mean age 38 years, range 26-57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8-22) mm, with 30 stones in the upper, 69 in the mid- and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter. RESULTS: MAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10-44) min and the hospital stay 42 (24-72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30-150) mL. The drain was removed after 5 (5-7) days. Patients reported using opioid or nonsteroidal anti-inflammatory analgesia for a mean of 4 (1-7) days after surgery. The mean time to resumption of work was 16 (8-35) days. CONCLUSIONS: MAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment.
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Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Doença Crônica , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Recidiva , Resultado do Tratamento , Ureteroscopia/efeitos adversosRESUMO
We present the first case of extrapelvic endometriosis (EPE) presenting as combined swellings of the thigh and buttock in a 28-year-old nulliparous woman. The diagnosis was aided by the history of cyclical symptoms, needle aspirate, ultrasonography and computed tomography scan and was confirmed by histological analysis of the excised specimens. Of note, laparoscopy showed the pelvis to be free of gross disease. Surgical excision combined with hormonal suppression therapy proved adequate treatment in preventing recurrence as well as the complications of wound implantation.
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Adulto , Feminino , Humanos , Endometriose , Coxa da Perna , Tomografia Computadorizada por Raios X , Laparoscopia , Endometriose , Diagnóstico Diferencial , Nádegas/patologiaRESUMO
Our study showed that of the 300 consecutive people interviewed at the General Hospital at Port-of-Spain, Trinidad, most persons (80%) preferred to be called 'patients' as opposed to 7% choosing the term 'client' and 6% opting for the term 'customer'. This proves our hypothesis that in the developing world people prefer to maintain the doctor-patient relationship and leave the word 'client' and 'customer' for the businessman.
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Atitude Frente a Saúde , Relações Hospital-Paciente , Hospitais Gerais , Pacientes , Relações Profissional-Paciente , Adolescente , Adulto , Idoso , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Terminologia como Assunto , Trinidad e TobagoRESUMO
We present the first case of extrapelvic endometriosis (EPE) presenting as combined swellings of the thigh and buttock in a 28-year-old nulliparous woman. The diagnosis was aided by the history of cyclical symptoms, needle aspirate, ultrasonography and computed tomography scan and was confirmed by histological analysis of the excised specimens. Of note, laparoscopy showed the pelvis to be free of gross disease. Surgical excision combined with hormonal suppression therapy proved adequate treatment in preventing recurrence as well as the complications of wound implantation.
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Endometriose/diagnóstico , Adulto , Nádegas/patologia , Diagnóstico Diferencial , Endometriose/cirurgia , Feminino , Humanos , Laparoscopia , Coxa da Perna/patologia , Tomografia Computadorizada por Raios XRESUMO
Paraphimosis usually develops when a tight foreskin is retracted over the glans penis for a prolonged period. Many esoteric aetiologies have been implicated in the development of paraphimosis including piercing the foreskin, Plasmodium falciparum infection, application of celadine juice to the foreskin, chancroid, pessaries and the implantation of pearls. We report the first two cases of paraphimosis developing during wining, an erotic dance native to Trinidad & Tobago.
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Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Parafimose , Pênis , Ereção Peniana , Trinidad e TobagoRESUMO
Caroli's disease or communicating ectasia of the intrahepatic biliary tree is a rare disease with unknown aetiology. The coexistence of this along with the uncommon condition of a gastric diverticulum has never been reported before. A deficiency in the fibromuscular matrix of both the bile ducts and the gastric wall may explain why these two pathologies may coexist in a single patient.
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Doença de Caroli/complicações , Divertículo Gástrico/complicações , Adulto , Doença de Caroli/diagnóstico , Divertículo Gástrico/diagnóstico , Feminino , HumanosRESUMO
Caroli's disease or communicating ectasia of the intrahepatic biliary tree is a rare disease with unknown aetiology. The coexistence of this along with the uncommon condition of a gastric diverticulum has never been reported before. A deficiency in the fibromuscular matrix of both the bile ducts and the gastric wall may explain why these two pathologies may coexist in a single patient.