Building artificial intelligence and machine learning models : a primer for emergency physicians.

There has been a rise in the number of studies relating to the role of artificial intelligence (AI) in healthcare. Its potential in Emergency Medicine (EM) has been explored in recent years with operational, predictive, diagnostic and prognostic emergency department (ED) implementations being developed. For EM researchers building models de novo, collaborative working with data scientists is invaluable throughout the process.

The Pushing Sign for Early Skin Tethering in Breast Cancer.

Skin tethering (ST) is regarded as a classical clinical feature of breast cancer. In many cases, ST is not evident on inspection, with the arm raised and skin pinching over the lump. We have observed that pushing the lump in one or another direction may elicit skin dimpling that was not otherwise evident.

Laparoscopic Completion Cholecystectomy: An Audit from the Americas Hepato-Pancreato-Biliary Association (AHPBA) Caribbean Chapter.

Objective Removal of a gallbladder remnant occasionally becomes necessary when retained stones become symptomatic. Although the laparoscopic approach has been described, it is not yet considered the standard of care. We sought to determine the outcomes after completion cholecystectomies in the resource-poor setting within the Caribbean.

Minimally invasive oesophagectomy: The first case report of a thoracolaparoscopic oesophagectomy done in the Caribbean.

Introduction: Minimally invasive oesophagectomy is one of the options in the armamentarium of a modern surgeon when faced with treating oesophageal cancer. Trinidad and Tobago has successfully treated a patient using this method. This case report adds to the rich surgical history in the Caribbean.

The caged bird sign of achalasia: A case series describing a new radiologic sign that can be reliably used in a resource-poor setting to diagnose achalasia.

Introduction: Achalasia is an uncommon oesophageal motility disorder caused by failed relaxation of a hypertensive lower oesophageal sphincter in response to swallowing. It often manifests clinically with symptoms such as dysphagia, regurgitation, and weight loss. Manometry is considered the gold standard diagnostic test in diagnosing this condition.

A case report of blunt cardiac rupture.

Introduction: Cardiac rupture is a full thickness laceration of the myocardium that occurs after blunt chest trauma. They are notoriously fatal, with only a handful of patients documented to have survived. These injuries are not commonly associated with low energy chest trauma and may be overlooked as a differential in trauma cases if health care providers are not aware of their possibility.

A Giant Gallstone: The Largest Gallstone Removed Laparoscopically in the World.

Trinidad and Tobago, a small twin island republic off the coast of Venezuela, is leading the Caribbean in laparoscopic surgery. While giant gallbladders are usually difficult to operate on and have a high conversion rate from laparoscopic to open procedure, in Trinidad and Tobago a laparoscopic cholecystectomy involving a giant gallbladder and the largest gallstone ever removed laparoscopically was performed uneventfully.

Totally Laparoscopic Whipple's Operation: Initial Report from the Caribbean.

Oncologic surgery in the Caribbean has evolved over the past decade, with increasing reports of advanced minimally invasive operations being performed. However, the minimally invasive approach has not been used for peri-ampullary lesions. This is because a laparoscopic Whipple's operation is a technically demanding and time-consuming operation.

Single incision laparoscopic surgery from a caribbean perspective.

Conventional laparoscopy with multiple ports has recently gained a strong foothold in the Caribbean, but single incision laparoscopic surgery (SILS) has lagged behind. In this paper, we compare the data on SILS and conventional multi-port laparoscopy in the English-speaking Caribbean.

Mature Cystic Teratoma Hiding in the Retroperitoneum of an Adult.

We report a rare case of a mature cystic teratoma found in the retroperitoneum of a 28-year-old woman with vague symptomatology. We review the radiologic and pathologic features of this rare lesion.

The steel pan sign of sigmoid volvulus-A case series.

Introduction: Signs in radiology are usually based on many common objects or patterns that are easily recognizable in everyday life. The objective behind this association is to aid in the understanding and diagnosis of the disease process. These signs can be seen in different imaging modalities such as plain radiograph and computed tomography.

CT guided appendicectomy incision: A prospective case series.

Objective: Several radiological studies have suggested that the base of the Appendix often does not correspond with Mc Burney's point. The aim of our study is to assess the value of using CT localization of the appendicocaecal junction to guide placement of the appendicectomy incision.

Design & Method: 32 consecutive patients, booked for open appendicectomy were prospectively included in this study.

Endoscopic thyroid surgery in the Caribbean: A case report of the first clinical experience.

Minimally invasive surgery is rapidly expanding its role in almost all of the surgical sub-specialties. There is also a growing demand of this service as patients became more and more concerned about cosmesis in addition to their original surgery. Although its role in thyroid surgery has already been proven earlier; but it is not yet accepted as a routine approach amongst many thyroid surgeons.

Retrograde Thyroidectomy for preservation of the External Branch of the Superior Laryngeal Nerve: A case series.

Background: The external branch of the Superior Laryngeal nerve (EBSLN) is at high risk of injury in surgery for large multinodular goitre (MNG) since the upper pole is high in the neck, well cephalad to the EBSLN. We present a technique of drawing the lobe caudally by retrograde thyroidectomy in order to minimize nerve injury.

Design & Method: All patients having surgery for benign MNG were included.

Rare liver tumor: symptomatic giant von Meyenburg complex.

von Meyenburg complexes are hamartomas that arise from intra-hepatic bile ducts. Symptomatic lesions are uncommon and giant lesions are exceedingly rare. When encountered, they should be excised because there are reports of malignant change in large, symptomatic lesions.

Pancreatic pseudocyst: combined single incision laparoscopic cystogastrostomy and cholecystectomy in a resource poor setting.

Laparoscopic cystogastrostomy is a well-accepted minimally invasive modality to treat pancreatic pseudocysts. There has been one prior report of cystogastrostomy via single incision laparoscopic surgery (SILS) in which specialized instrumentation and access platforms were used.We report the challenges encountered in a low resource setting with the SILS approach to drainage using only standard laparoscopic instruments.

Delayed splenic abscess after laparoscopic sleeve gastrectomy.

Splenic abscesses complicating sleeve gastrectomies are extremely rare. We report the fourth recorded case of a splenic abscess; in our case it occurred 10 weeks after sleeve gastrectomy in a 44-year-old man. The clinical presentation was vague but included the triad of fever, left upper quadrant tenderness and leucocytosis.

Clinical outcomes of single incision laparoscopic cholecystectomy in the anglophone Caribbean: a multi centre audit of regional hospitals.

Introduction: There has been no report on Single-Incision Laparoscopic Surgery (SILS) cholecystectomy outcomes since it was first performed in the Anglophone Caribbean in 2009.

Methods: A retrospective audit evaluated the clinical outcomes of SILS cholecystectomies at regional hospitals in the 17 Anglophone Caribbean countries. Any cholecystectomy using a laparoscopic approach in which all instruments were passed through one access incision was considered a SILS cholecystectomy.

Bariatric surgery in the Caribbean: is it safe in a low-volume, third world setting?

Bariatric surgery is a well-recognized modality of management of obesity. In addition to obesity, it effectively controls diabetes mellitus, and hypertension. It has been recommended that bariatric surgery should be done in "designated centers" of excellence where there is a high volume of case turnover.

Minilaparotomy cholecystectomy--an appropriate alternative to laparoscopic cholecystectomy in developing nations.

Background: This study reports the experience of performing minilaparotomy cholecystectomy (MC) and assesses the peri-operative outcome of this surgery in the setting of a developing country.

Methods: Data of all patients who underwent minilaparotomy cholecystectomy by a single surgical unit were collected and reviewed. These included demographics, surgical technique used, peri-operative complications and length of hospital stay.

Effects of bariatric surgery on type-2 diabetes mellitus in a Caribbean setting.

Objectives: To determine if there is a beneficial effect of bariatric surgery in the management of Diabetes Mellitus in obese patients in a Caribbean setting.

Methods: A retrospective review of charts of all obese patients with Type-2 Diabetes Mellitus (DM) who had undergone Laparoscopic Roux en Y gastric bypass (LRYGBP) over a 4 year period was undertaken and clinical data recorded. A questionnaire was prospectively administered via telephone to determine the quality of life.

Laparoscopic cholecystectomy: analysis of 619 consecutive cases in a Caribbean setting.

Introduction: Laparoscopic cholecystectomy has become the gold standard in the definitive treatment of symptomatic gall bladder disease. It boasts superior morbidity and mortality and lower complication rates than open approaches.

Aim: This study outlines the experiences associated with 619 laparoscopic cholecystectomies performed in Trinidad.

Laparoscopic cholecystectomy in sickle cell disease patients: does operating time matter?

Objectives: To report the experience of performing laparoscopic cholecystectomy (LC) in patients suffering from sickle cell disease (SCD), and to assess if their postoperative complications can be minimized by shortening the operating time.

Methods: Strict measures were taken to minimize the operating times and duration of pneumoperitoneum in SCD patients undergoing LC. Data collected included demographics, preoperative haemoglobin, the surgical technique used, operating times, insufflation pressures, perioperative complications and hospital length of stay.