Biomedical subjects
Publications and source records attributed to V Naraynsingh.
Advanced Trauma Life Support (ATLS) training of medical staff did not improve outcome of the trauma victim. Potential benefit of this course may have been masked by weak links in the trauma care chain such as pre-hospital care and in hospital investigative and therapeutic facilities.
Because there are several specific disadvantages to a colostomy in a developing country, primary repair for colon injury was electively performed. Sixty-one consecutive patients with colon injury were seen between 1978 and 1989 and 57 of these (93 per cent) underwent primary repair. In four a colostomy was constructed. Emergency repair was carried out regardless of site or mode of injury, presence of hypotension or peritoneal contamination. There was one death unrelated to anastomotic complications and one anastomotic leakage. The faecal fistula closed spontaneously in 4 weeks. The wound infection rate was 10 per cent. These data support the emerging view that primary repair of colon injury is the management of choice.
Thirty-two consecutive cases of left-sided colonic obstruction are presented. Thirty cases were managed by primary resection and anastomosis without colostomy. No anastomotic leakage occurred. This procedure allowed significant conservation of material and personnel resources, with minimal patient morbidity.
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A retrospective review of breast cancer in West Indian women in Trinidad is presented. Breast cancer constituted 17% of all cancers diagnosed and represented 26% of all cancers in females. The usual presenting symptom was a painless lump. The right breast and the upper outer quadrant were the common site of cancer. 85% of the patients were multiparous with an average of 4 children and 92% of them breast fed. Most patients presented in stage I disease, but a significant number of cases were in an advanced stage of the disease. Infiltrating duct carcinoma was the most frequent histological diagnosis and lobular carcinoma was seen in 1% of the cases.
Adenomyosis was noted in 16% of 2,616 consecutive hysterectomy specimens examined during a 7-year period. Multiparas between the ages of 30 and 50 years were most commonly affected. Abnormal uterine bleeding was the common symptom. Myohyperplasia and leiomyomas were the usual associated lesions. Adenomyosis uteri was seen equally in women of African, Indian and mixed races in this West Indian population.
Intussusception is the commonest cause of intestinal obstruction in childhood in Trinidad. A review of 94 consecutive cases seen at the General Hospital, Port-of-Spain, over a 12-year period (1974-1985) indicates that there had been a very rapid increase in incidence of intussusception in the last 4 years. The majority were under 1 year of age (87%) and there was a predominance in the Negro child (62%). Male to female ratio was 1.2:1. A high misdiagnosis rate (55%) lead to inappropriate treatment and delay in surgical intervention. This resulted in a high case fatality (6.4%) and complication rate. In order to minimize morbidity and mortality from intussusception steps must be taken to ensure earlier diagnosis and treatment.
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Granular cell tumours occur in a variety of sites, including the vulva. Origins from myogenic, histiocytic, fibroblastic and neurogenic elements have been proposed. Female preponderance suggests that oestrogenic hormones are involved. Seven cases of granular cell tumours of the vulva have been studied. In none was the correct diagnosis made preoperatively. They were solitary lesions and local excision was curative. Paraffin sections of these cases were studied by peroxidase-antiperoxidase method for myoglobin, lysozyme, alpha-1-antitrypsin and S-100 protein localization. Antimyoglobin, antilysozyme and anti-alpha-1-antitrypsin antibodies were not localized in these tumours; however, S-100 protein was localized in all of them. These results agree with previous data that suggest a neurogenic origin for granular cell tumours.
Although gastric strangulation in an inguinal hernia has been reported on three previous occasions, recurrent gastric outlet obstruction due to this hernia has not been previously documented. Prolonged traction on the distal stomach by omentum and transverse colon can draw the antrum and pylorus into the hernia and produce gastric outlet obstruction.
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