Biomedical subjects

M Arthurs

Publications and source records attributed to M Arthurs.

8 recordsLinked to original sources

PubMed2006

Laparoscopic cholecystectomy for chronic cholecystitis in Jamaican patients with sickle cell disease: preliminary experience.

Laparoscopic cholecystectomy, with its advantages of reduced postoperative pain and shorter hospitalization is the accepted standard of care for patients with symptomatic cholelithiasis. A retrospective study was done to assess the outcome of laparoscopic cholecystectomy in patients with sickle cell disease, a group known for its high postoperative morbidity. The study sample comprised of patients seen at the University Hospital of the West Indies during the period 1999 to 2004. Twelve patients were females and four were males. Their mean age was 28.5 years (range 13-43 years). Fifteen underwent elective cholecystectomy for recurrent episodes of cholecystitis while one patient required an emergency procedure. All patients underwent endoscopic retrograde cholangiopancreatography, which successfully removed common bile duct stones which were present in 25% of the cases. There were four conversions to open cholecystectomy as a result of obscure anatomy due to scarring and adhesions. The duration of surgery ranged from 70-150 minutes. Six patients developed postoperative complications, four of whom had acute chest syndrome. This resulted in death in one patient. The mean postoperative hospitalization period was 5.5 days. This report indicates that patients with sickle cell disease remain a high risk group with the potential for significant morbidity even when subjected to minimal access surgery.

Adolescent↗

PubMed2006

A comparison of open and laparoscopic cholecystectomy done by a surgeon in training.

Laparoscopic cholecystectomy has virtually replaced conventional open cholecystectomy as the gold standard for symptomatic cholelithiasis. The laparoscopic approach brings numerous advantages at the expense of higher complication rates, especially in training facilities. This comparative 18-month review examines the outcomes of 52 cholecystectomies performed by a single surgical resident at the University Hospital of the West Indies--a teaching hospital in Jamaica. The advantages of laparoscopic cholecystectomy have been demonstrated and it has been found to be safe and effective in this training facility.

Adolescent↗

PubMed2004

Endoscopic retrograde cholangiopancreatography use at the University Hospital of the West Indies.

All patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at the University Hospital of the West Indies (UHWI) were entered into a prospective database. Parameters included demographics, indication for the procedure, success of the ERCP and any immediate complications noted. Retrospectively, the patients' case notes were analyzed for complications developing after 24 hours, and outcome. During the period March 1999 to December 2002, a total of 120 consecutive patients were subjected to 123 ERCPs, all being performed by a single gastroenterologist. Of these 120 patients, eight had ERCP as outpatients and were transferred back to their referring hospitals. These patients were excluded from further analysis. Of the 115 UHWI patients, the case notes of 96 were available for analysis and this group formed the basis of this review. ERCP had successful cannulation in 95% of patients. There were 70 females and 26 males with a female to male ratio of 2.7:1. Age ranged from 13 to 85 years (mean +/- SD, 43 +/- 17), males being an average six years older than females. The most common indication for ERCP was a patient with cholelithiasis and abnormal liver function tests scheduled for laparoscopic cholecystectomy. This made up 33% of patients and in this subgroup, sickle cell disease accounted for 50% of cases. Patients with common bile duct stones preoperatively and post-cholecystectomy accounted for 13% and 17% respectively while gallstones pancreatitis accounted for 13% of cases, including three patients with severe pancreatitis. While 64% of the patients had normal cholangiogram, 66% of them had sphincterotomy. Common bile duct stones were seen in 23 cases and complete removal was successful in 48%. There were ten cases (10%) of ERCP pancreatitis and this was severe in three patients and the direct cause of death in one. One patient had ascending cholangitis post ERCP and there were no cases of post-sphincterotomy bleeding or duodenal perforation. Endoscopic retrograde cholangiopancreatography at the UHWI has high diagnostic yield but its therapeutic use needs further development.

Adolescent↗

PubMed2004

Antibiotic sensitivity of Helicobacter pylori in Jamaica.

Helicobacter pylori infection is one of the commonest chronic infections worldwide. Eradication regimes usually contain two antibiotics, however resistance is increasing and this decreases treatment success. This study reports on the sensitivity and resistance of H pylori to several antibiotics in patients undergoing upper gastrointestinal endoscopy in Jamaica. The rapid urease test (CLO) was positive in 128 (38%) of 336 patients. Fifty patients (39%; 50/128) with positive CLO tests had positive cultures for H pylori. Two-thirds (32/48) of islolates were sensitive to metronidazole and one-third (16/48) were resistant. Ninety-seven per cent of isolates (31/32) were sensitive to erythromycin. The sensitivity for clarithromycin was 92% (11/12) with one isolate (8%) resistant. All strains of H pylori (48/48) were sensitive to ampicillin and amoxicillin - clavulanate. Metronidazole resistance is present in one-third of H pylori isolates and resistance to macrolides is relatively low in Jamaican patients. It is important to monitor antibiotic resistance in order to provide clinicians with data on the most appropriate and cost effective eradication regimes for H pylori.

Aged↗

PubMed1997

Thyrotoxic vomiting. A case report.

A post menopausal female with severe vomiting and weight loss in association with elevated thyroid hormone levels is presented. Signs and symptoms of thyrotoxicosis were not evident at presentation. Possible pathophysiological mechanisms and treatment are discussed. Antithyroid therapy with carbimazole and propranolol induced rapid resolution of her symptoms and marked improvement in well-being. Radioactive iodine ablation of her thyroid gland was performed later and she has remained asymptomatic.

Combined Modality Therapy↗

PubMed1994

Helicobacter pylori in patients undergoing upper endoscopy in Jamaica.

One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were tested for H. pylori by a rapid urease test, using antral biopsy specimens. There were 60 men (mean age 54 yrs) and 42 women (mean age 49 yrs). Fifty-six patients (55%) were positive for H. pylori. Of male patients, 36 (60%) and of female patients, 20 (48%) tested positive. Sixty-eight per cent of patients with antral gastritis, 65% with duodenal ulcer and 60% with gastric ulcer had H. pylori. Thirty-nine patients (70%) positive for H. pylori were from major urban areas, and 17 (30%) were from rural areas of Jamaica. In patients without H. pylori, 61% and 39% were from urban and rural areas, respectively. Forty-four patients (79%) with H. pylori and 40 (87%) without H. pylori had piped water in their homes. Ninety-three per cent of all patients had electricity and 88% had refrigeration. There was no difference between patients positive or negative for H. pylori with regard to the use of alcohol, marijuana or tobacco. There was also no difference between both groups in exposure to domestic animals in the home environment. H. pylori is associated with antral gastritis and peptic ulcer disease in Jamaican patients. There are no specific environmental or social factors that seem to predispose to infection.

Duodenitis↗

PubMed1994

Primary antiphospholipid syndrome. A case report.

A case of the primary antiphospholipid syndrome (PAPS) in a 21-year-old Jamaican female is described. Recurrent abortions, thrombocytopenia and neurological complications as well as lupus anticoagulant positivity in the absence of features of systemic lupus erythematosus (SLE) were the main clinical findings. Diagnostic criteria, treatment and prognosis are discussed. When the antiphospholipid syndrome (APS) is present in the primary form, the diagnosis may be difficult but its recognition may prevent those vascular events which can lead to significant morbidity and foetal wastage.

Abortion, Habitual↗

PubMed1992

Thyrotoxic periodic paralysis in a Jamaican male patient.

A case of thyrotoxic periodic paralysis occurring in a Black Jamaican male patient is described. Diagnosis is based on history and confirmed by evaluation of serum electrolyte during attacks and thyroid function studies. The pathophysiology, associations, therapy and prognosis are discussed. It is important that clinicians recognise the condition as all forms of periodic paralysis are amenable to treatment, and progressive weakness can be prevented or even reversed.

Adult↗