Cervical osteomyelitis associated with intravenous drug use.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
M J Ramdass
Publications and source records attributed to M J Ramdass.
Traumatic diaphragmatic herniation presenting as a delayed tension faecopneumothorax.
This article reports an unusual case of delayed presentation of a tension faecopneumothorax after traumatic injury to the diaphragm 5 years previously. Three important clinical lessons are highlighted: (a) for suspected tension pneumothorax, if a considerable quantity of serous fluid is drained in addition to air, a communication with the peritoneal cavity should be considered; (b) spontaneous tension pneumothorax is an extremely rare condition and other causes should be kept in mind; and (c) in the presence of a tension pneumothorax and diaphragmatic hernia, the contents of the visceral sac may be completely reduced and the hernia may be masked.
Adult↗
Delayed repair of a fractured penis: a new technique.
Fracture of the penis can be managed conservatively or surgically. Conservative management is associated with a high morbidity, and early surgical repair of the fracture is usually recommended in order to prevent complications. Because a fractured penis is swollen throughout its length, it is difficult to identify the fracture site accurately, so a degloving technique is usually used to locate and repair the torn corpus cavernosum; this can lead to further trauma and complications. In cases where extensive swelling makes accurate clinical localisation difficult, delaying the repair for 7-12 days facilitates easy identification and repair of the torn corpus cavernosum. We report three cases where treatment was delayed until the swelling had subsided, when a simple direct repair was successfully carried out.
Adult↗
McBurney's point: are we missing it?
A prospective study of 100 post-evacuation barium enemas was done. Films were centered at McBurney's point, with an opaque skin marker at that point. Analysis of these revealed that in only one case (1%) was the base of the appendix at McBurney's point. In 67% it was cephalic and in 32% it was caudal to this point. The limitations of McBurney's point as an anatomical landmark should be recognized. This needs to be highlighted in teaching anatomy, especially to surgical trainees. Planning and choice of surgical incisions should be based on an understanding of these anatomical variations since McBurney's original description was clinical rather than anatomical.
Adolescent↗
Obturator hernia repair--a new technique.
Obturator hernia is a rare condition with few reports in the world literature. There appears to be no consensus on the ideal approach and repair for such a condition. We report a simple, quick technique via a lower midline incision using an autogenous peritoneal fold. It is ideal for the contaminated case and in settings where mesh is not readily available.
Aged↗
Pedicled flaps in reconstructive surgery.
An audit was conducted of pedicled flaps used in reconstructive surgery in Trinidad from 1983 to 2000. This consisted of 65 flaps. There were four cases of partial flap necrosis: three involving tram flaps and the other involving the metacarpal artery flap. There were no cases of total flap loss. Pedicled flap coverage provides immediate closure of potentially difficult wounds. This early cover reduces the risk of infection as a result of increasing the blood supply and providing a physical barrier. This contributes to a shorter hospital stay and earlier rehabilitation. Our present team approach with the inclusion of a reconstructive surgeon now allows for uncompromised débridement in trauma and oncological resection.
Female↗
Slow decompression of the bladder using an intravenous giving set.
Rapid decompression of the bladder has been associated with complications such as diuresis, hyperkalaemia, haematuria and hypotension. Although these complications are easily managed and rarely clinically significant, clinicians still practise slow decompression using a 'clamping' technique. Slow decompression using a giving set provides a more convenient and less time-consuming way of achieving this goal.
Acute Disease↗
Peritoneal encapsulation: a preoperative diagnosis is possible.
Peritoneal encapsulation is an exceedingly rare developmental abnormality in which the small intestine is encased in an accessory peritoneal sac between the omentum and mesocolon. Two clinical signs associated with the dense fibrous layer encapsulating the intestine are described. The first is a fixed, asymmetrical distension of the abdomen, which does not vary with peristaltic activity due to the unvarying position of the fibrous capsule. The second is the difference in the consistency of the abdominal wall to palpation. The flat area is firm, due to the dense fibrous capsule and the distended area soft, due to the thin walled distended small intestine with no overlying fibrous layer.
Diagnosis, Differential↗
Case report. Paraphimosis due to erotic dancing.
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.
Adolescent↗
Question of 'patients' versus 'clients'.
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.
Adolescent↗