Adult intussusception in Trinidad.
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Biomedical subjects
Publications and source records attributed to V Naraynsingh.
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Thirty post-menopausal women with breast abscess were treated at Port of Spain General Hospital, Trinidad, between 1976 and 1980. In this age group, breast abscess can be confused with cancer due to a lack of inflammatory features. History and physical examination are often not helpful in differentiating an abscess from carcinoma. Although the usual treatment of an abscess is incision and drainage, in post-menopausal women, excision of the lesion is helpful for accurate histological diagnosis.
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Gastric carcinoma, the commonest cause of death from malignant disease in Trinidad, has decreased steadily over the period 1968-1977. Of the 1052 deaths during this time, females accounted for a relatively high percentage (45%) of cases. There is a predominance of antral tumors, and most cases present with very advanced disease (88% with Stage III & IV). This results in a low resectability rate (32%). Its racial predilection for blacks of the lower income group suggests that both genetic and environmental factors may be important. The possible role of dietary factors is discussed.
In order to define the respective roles of the vasa vasorum blood supply and intraluminal arterial blood flow in maintaining the endothelial integrity of in situ vein bypasses, we have carried out two separate but interrelated experiments in a canine model. In vivo studies on eight dogs demonstrated that even in the absence of intraluminal blood flow the vasa vasorum maintained endothelial integrity and also showed that the endothelium was very sensitive to the loss of the vasa vasorum blood supply. In a second group of experiments on 14 in situ vein bypasses we studied the effect of division of the vasa vasorum immediately after arterialization of the bypass. This experiment showed that arterialization of the vein maintained endothelial integrity despite division of the vasa vasorum.
A review of 1726 breast lesions in West Indian women from Trinidad showed that the pattern of disease is significantly different from that reported in whites but similar to reports from India and Africa. This difference is mainly due to the high frequency of fibro-adenoma in our adolescent women. Fibro-adenoma was the commonest lesion (39.3 per cent), followed by mammary dysplasia (32 per cent) and carcinoma (21 per cent). Although carcinoma comprised only 21 per cent of all breast lesions, nearly 40 per cent of true neoplasms were malignant. We believe all suspicious breast lumps in black women need biopsy and further analysis of morphological components of benign breast lesions is necessary to evaluate precursors to cancer of the breast.
An experience with six cases of fractured penis is described. A 'rolling sign' accurately identifies clot at the fracture site and facilitates a direct and rapid approach to the torn corpus cavernosum. Early operation hastens recovery and limits deformity.
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This report evaluates critical points in the management of 30 consecutive blunt traumatic popliteal vascular injuries. All arterial injuries were diagnosed both clinically and by Doppler and PVR examinations. Twenty-eight of the 30 arterial reconstructions required interposition bypass grafts, nine of which were PTFE and the remainder were autogenous saphenous veins. In 19 patients the distal anastomosis was made to the distal popliteal artery and in nine patients to the tibial-peroneal arteries. In ten patients in whom limb survival was threatened, the ischemic time was shortened by the use of temporary Silastic shunt for rapid restoration of arterial flow. Nine patients had associated venous injuries which were repaired. Nine of the first 14 patients required fasciotomy but the last 16 patients were treated with hypertonic mannitol and only two of them required fasciotomy. There were no amputations, but in four limbs there were functional losses. In spite of the more extensive damage of blunt trauma, prompt and aggressive management aided by vascular laboratory tests, indwelling shunt, and hypertonic mannitol is rewarded with preservation of limbs following acute popliteal vascular injuries.
This paper describes multiple breast fibroadenomas in three siblings. It appears that the familial disorder seen is associated with bilateral multiple fibroadenomas.