Superficial palmar arch aneurysm secondary to blunt trauma: Bag of ice versus bare hand!

A 45-year-old male prisoner was referred to the orthopedic outpatients clinic after he sustained a blunt palmar injury when he tried to break-up a bag of ice with the volar aspect of his hand. A few months later a pulsatile expansile mass developed at the site of blunt trauma affecting flexion and extension of the fingers and inability to hold objects. A computed tomography angiogram confirmed the mass to be a true aneurysm of the superficial palmar arch 3 cm in size.

Characteristics and Ethnic Distribution of Aortic Aneurysms in a Caribbean Cohort.

Background:  There is a paucity of data regarding relationships between patient demographics and aneurysm characteristics in the West Indies. With this in mind, a retrospective cross-sectional review was conducted analyzing the computed tomography aortogram reports/images of 273 aortic aneurysms.

Methods:  Data were collected and analyzed on ethnicity, size, type, morphology, presence and maximum size of thrombus and aneurysm location, demographics, and clinical presentation with correlations.

Gender Influence on Abdominal Aortic Aneurysm Surgery in a Caribbean Population.

Female patients with abdominal aortic aneurysms (AAAs) are usually less common and older than their male counterparts. We report on AAA disease in a Caribbean nation with respect to gender and review their outcomes relative to the male population. Data were collected prospectively and analyzed retrospectively for patients with AAAs who underwent surgery from 2001 to 2018.

Breast Carcinoma Receptor Expression in a Caribbean Population.

Trinidad and Tobago are islands in the Southern Caribbean with a unique mix of races within the population consisting of East Indian (EI) (37.6%), Afro-Caribbean (AC) (36.3%), mixed (24.

Comment on 'Achenbach syndrome in an older man'.

We comment on a previous letter regarding Achenbach syndrome, and suggest that punch biopsy should be performed in all clinically suspected cases to obtain histological confirmation of the disease.

Achenbach's Syndrome Revisited: The Paroxysmal Finger Hematoma May Have a Genetic Link.

Achenbach's syndrome describes the sudden occurrence of bruising, pain and swelling of one or more digits of the hand involving the volar aspect of the proximal and middle phalanges. Also known as the paroxysmal finger hematoma, it presents in dramatic fashion, sometimes with a prodrome of tingling, itching or numbness but despite its dramatic presentation, all investigations are normal. Routine blood investigations, as well as coagulation and thrombophilia screens are all negative as are vascular imaging and echocardiography.

Extrahepatic biliary obstruction secondary to metastatic esophageal squamous cell carcinoma: An unusual presentation of Courvoisier's law.

Courvoisier's law states, "In the presence of jaundice and a palpable bladder, the cause is unlikely to be due to stone". Although esophageal squamous carcinoma is known to spread to celiac nodes, there is no description in the literature with it presenting and mimicking the above findings in Courvoisier's Law.

Lessons Learned after Iatrogenic Complete Transection of the Right Common Carotid Artery with Segmental Vessel Loss.

Carotid arterial injuries occur in 5-6% of persons with penetrating trauma. Complete transection is rare in civilian practice and is most often due to penetrating injuries. Complete transection as an iatrogenic complication is rare.

Femoro-distal bypass in a 5-year old with blunt popliteal artery trauma: Considerations in a limited resource setting.

Blunt popliteal vascular injury in the paediatric population is exceedingly rare and in advanced trauma centres the management can be challenging. A case of blunt popliteal artery trauma in a 5 years old requiring distal bypass using reversed saphenous vein is herein described. It is noteworthy to mention the difficulties experienced in a limited resource setting, including limitations in small rural hospitals, inefficient timely transfer to specialised centres, inadequate numbers of highly trained surgeons in subspecialities such as microvascular surgery and finally ineffective support and rehabilitative services.

Dermatofibrosarcoma protuberans associated with trauma: A case report.

A case of dermatofibrosarcoma protuberans (DFSP) in a 22-year old female associated with blunt trauma of the mid-upper back is presented in the current study with a review of the literature. DFSP is a rare slow growing sarcoma of the soft tissue most commonly seen on the trunk and upper extremities with a low to intermediate grade malignant potential, high chance of local invasion and a high local recurrence rate. The literature search revealed that both non-congenital mutation as well as trauma serve a role in the development of this dermal neoplasm, but the exact mechanism by which trauma may predispose to development of DFSP is unknown.

Extreme traumatic arteriovenous fistula of the upper limb.

Traumatic arteriovenous fistula with steal syndrome of the extremity is rare. A useful technique is herein described involving complete ligation of the fistulous connection with a distal bypass procedure done using reversed great saphenous vein to salvage the upper limb.

A historical perspective on the introduction of laparoscopic basic surgical training in the Caribbean and factors that contribute to sustainability of such training.

Objective: To report the development of minimally invasive training courses and workshops in the Caribbean and specifically the establishment of the Basic Surgical Skills Course of the Royal College of Surgeons of England (RCSEng) in Trinidad with respect to their value toward Surgical laparoscopic or minimally invasive training in the Caribbean.

Design: & Methods: The literature written on laparoscopy in the region was reviewed and in particular that related to the minimally invasive training courses provided over the period 2004 to 2019 and the development of laparoscopic surgical training described from a historic perspective. The factors that contribute to sustainability of courses were identified.

Distal-to-Snuffbox Arteriovenous Fistula.

The dogma for optimal arteriovenous fistula (AVF) creation is based on starting as distally as possible on the upper limb and progressing proximally. We herein present our findings of an AVF that is as distal as possible on the hand. To document primary patency rates of the distal-to-snuffbox AVF.

Risk factors associated with amputation in civilian popliteal artery trauma.

Popliteal artery trauma is uncommon but is associated with a high risk of limb loss depending on the scenario involving blunt or penetrating trauma as well as the severity and extent of injury that has occurred. In our setting there is a significant amount of gang and civilian warfare resulting in Vascular Trauma. There were 32 patients over a decade who sustained traumatic injury to the popliteal artery consisting of 30 males (94%) and 2 females with an age range 16-59 years with a mean of 32.

Brachial Artery Reconstruction in Trauma Using Reversed Arm Vein from the Injured Upper Limb.

Background: Brachial artery repair may be technically challenging with a paucity of guidelines. The use arm vein (AV) from the traumatized limb is herein described.

Methods: Data were prospectively collected from 2002 to 2016 on brachial artery injury including age, sex, mechanism/site of injury, and repair technique.

An 8-YEAR analysis of bone tumours in a Caribbean island.

Background: An epidemiologic analysis of bone tumours in Trinidad & Tobago.

Methods: A retrospective analysis of primary and secondary bone tumours, site of origin and demographic data was conducted.

Results: 63 bone tumours were analysed and included 27 primary benign (43%), 12 primary malignant (19%), 19 metastatic (30%) and 5 by contiguous spread (8%).

The curled sebaceous horn.

The mysterious sebaceous horn (devil's horn) is a historically perplexing phenomenon of unknown etiology. It classically occurs on the sun-exposed areas of the face and hands and consists of a keratin mound with a benign base in most cases and squamous cell carcinoma occurring in about 20% of patients.

Metastatic Invasive Sweat Gland Adenocarcinoma of the Hand with Upper Limb Amputation/Shoulder Reconstruction.

A rare case of metastatic invasive sweat gland adenocarcinoma of hand in a 78-year-old woman is presented. From this analysis of the available literature, it seems that these rare primary tumors of the hand are aggressive tumors with little known about their biological behavior. Fluoropyrimidines, taxanes, and cisplatin have been reported to be active agents for metastatic sweat gland carcinomas.

Declaration of a state of emergency in Trinidad and Tobago: effect on the trauma admissions at the National Referral Trauma Centre.

Objective: To determine the effect of a State of Emergency (SOE) on penetrating injuries at the main trauma center in Trinidad and Tobago.

Methods: Emergency room registers were accessed in order to identify all patients treated for penetrating injuries from July 1, 2010 through December 30, 2012. This study period was chosen to include injuries one year before and one year after the SOE that spanned from August 21, 2011 to December 5, 2011.

Incidence of tongue carcinoma in Trinidad and Tobago, West Indies.

The incidence of tongue carcinoma in Trinidad and Tobago and the greater West Indies is unknown; therefore, the present study examines the frequency of tongue carcinoma cases, drawing comparisons to worldwide and regional data. A retrospective analysis of all confirmed cases of tongue carcinoma was conducted using eight years of data from the pathology records at the Port of Spain General Hospital (Port of Spain, Trinidad and Tobago). A total of 26 cases were confirmed, of which 21 were male (81%) and five were female (19%).

Parotid gland tumours in a West Indian population: Comparison to world trends.

The epidemiology of parotid gland tumours in Trinidad and Tobago and the wider Caribbean is currently unknown. Therefore, an analysis of the pathological records was conducted to determine the pattern of this disease in Trinidad and Tobago. A retrospective analysis was conducted on all parotid gland tumours and the demographic and histological data were analysed.