Ablation of the great saphenous vein can be performed using endovascular technology and has repla... more Ablation of the great saphenous vein can be performed using endovascular technology and has replaced stripping as the procedure of choice to treat truncal varicosities. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.
Gouty tenosynovitis may present as infection, tendon rupture, nerve compression and/or digital st... more Gouty tenosynovitis may present as infection, tendon rupture, nerve compression and/or digital stiffness. We report a case of tophaceous gout which presented as bilateral carpal tunnel syndrome.
The prevalence of diabetes mellitus, diabetic foot (DF) disease and, as a result, lower extremity... more The prevalence of diabetes mellitus, diabetic foot (DF) disease and, as a result, lower extremity amputation rates remain high in the Caribbean. This study was undertaken to determine whether Caribbean countries have designated individuals that monitor DF disease and whether there are DF protocols consistent with the International Working Group on the Diabetic Foot (IWGDF) guidance documents. Relevant DF health care personnel(s) from the CARICOM and Dutch Caribbean countries were called or sent questionnaires regarding the presence of structured programs to monitor and manage DF problems in the population. All 25 countries (100%) responded. 81% of respondents could not identify any Ministry, Hospital or individual initiatives that monitored the DF. Only 9 (36%) countries had any guidelines in place. Only 3 countries with guidelines in place utilized IWGDF guidelines. Only 6 (24%) countries had podiatrists and 10 (40%) had vascular surgery availability. 7 (28%) countries had the components for a multidisciplinary team. The presence or the appointment of a designated individual and/or a multidisciplinary approach within the countries for DF disease was absent in the majority of respondent countries. Only a minority of countries implemented DF guidelines or had expertise available to organize a DF multidisciplinary team. Vascular surgery and podiatric care were noticeably deficient. These may be critical factors in the variability and reduced success in implementation of strategies for managing DF problems and subsequent amputations amongst these Caribbean countries.
Objectives We sought to determine the baseline demographic and clinical characteristics of patien... more Objectives We sought to determine the baseline demographic and clinical characteristics of patients with Chronic Venous Disease (CVD) across the Caribbean, and to evaluate patients’ compliance to conservative therapy and the effectiveness of such therapy in reducing patients’ CVD symptoms. Method Patients were enrolled into the VEIN Act Program, and their demographic data, CVD symptoms (and their intensity) and CEAP C-classification was recorded at the first visit. Patients were prescribed conservative therapy, and symptom intensity and patient compliance and satisfaction evaluated at a follow-up visit. Results We enrolled 193 patients into the study, most of which (76%) were female, between 39–78 years (80%) and within the C2-C4a classes (56.1%). Pain (61.1%) and heaviness (58.5%) were the most common symptoms. Patient compliance to the prescribed treatment was relatively high for all modalities (>75%) and most patients (92.1%) were at least somewhat satisfied with their treatme...
Though rare, fracture of the penis is associated with significant morbidity if early surgical rep... more Though rare, fracture of the penis is associated with significant morbidity if early surgical repair is not carried out. A simple same-day surgical technique performed under local anaesthesia is presented that requires no pre-operative investigations. Careful clinical examination (rolling sign) is used to accurately identify the fracture site.
Carotid endarterectomy is performed for symptomatic and asymptomatic carotid disease. The eversio... more Carotid endarterectomy is performed for symptomatic and asymptomatic carotid disease. The eversion carotid endarterectomy is one technique for performing carotid endarterectomy that is gaining popularity. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.
The left retroperitoneal posterior lateral approach for repair of abdominal aortic aneurysms offe... more The left retroperitoneal posterior lateral approach for repair of abdominal aortic aneurysms offers excellent exposure of the subdiaphragmatic aorta and its branches. It is ideal for pararenal, suprarenal, and Type IV thoracoabdominal repairs as well as in patients who are obese and have hostile abdomens or horseshoe kidneys. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.
Ablation of the great saphenous vein can be performed using endovascular technology and has repla... more Ablation of the great saphenous vein can be performed using endovascular technology and has replaced stripping as the procedure of choice to treat truncal varicosities. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.
Gouty tenosynovitis may present as infection, tendon rupture, nerve compression and/or digital st... more Gouty tenosynovitis may present as infection, tendon rupture, nerve compression and/or digital stiffness. We report a case of tophaceous gout which presented as bilateral carpal tunnel syndrome.
The prevalence of diabetes mellitus, diabetic foot (DF) disease and, as a result, lower extremity... more The prevalence of diabetes mellitus, diabetic foot (DF) disease and, as a result, lower extremity amputation rates remain high in the Caribbean. This study was undertaken to determine whether Caribbean countries have designated individuals that monitor DF disease and whether there are DF protocols consistent with the International Working Group on the Diabetic Foot (IWGDF) guidance documents. Relevant DF health care personnel(s) from the CARICOM and Dutch Caribbean countries were called or sent questionnaires regarding the presence of structured programs to monitor and manage DF problems in the population. All 25 countries (100%) responded. 81% of respondents could not identify any Ministry, Hospital or individual initiatives that monitored the DF. Only 9 (36%) countries had any guidelines in place. Only 3 countries with guidelines in place utilized IWGDF guidelines. Only 6 (24%) countries had podiatrists and 10 (40%) had vascular surgery availability. 7 (28%) countries had the components for a multidisciplinary team. The presence or the appointment of a designated individual and/or a multidisciplinary approach within the countries for DF disease was absent in the majority of respondent countries. Only a minority of countries implemented DF guidelines or had expertise available to organize a DF multidisciplinary team. Vascular surgery and podiatric care were noticeably deficient. These may be critical factors in the variability and reduced success in implementation of strategies for managing DF problems and subsequent amputations amongst these Caribbean countries.
Objectives We sought to determine the baseline demographic and clinical characteristics of patien... more Objectives We sought to determine the baseline demographic and clinical characteristics of patients with Chronic Venous Disease (CVD) across the Caribbean, and to evaluate patients’ compliance to conservative therapy and the effectiveness of such therapy in reducing patients’ CVD symptoms. Method Patients were enrolled into the VEIN Act Program, and their demographic data, CVD symptoms (and their intensity) and CEAP C-classification was recorded at the first visit. Patients were prescribed conservative therapy, and symptom intensity and patient compliance and satisfaction evaluated at a follow-up visit. Results We enrolled 193 patients into the study, most of which (76%) were female, between 39–78 years (80%) and within the C2-C4a classes (56.1%). Pain (61.1%) and heaviness (58.5%) were the most common symptoms. Patient compliance to the prescribed treatment was relatively high for all modalities (>75%) and most patients (92.1%) were at least somewhat satisfied with their treatme...
Though rare, fracture of the penis is associated with significant morbidity if early surgical rep... more Though rare, fracture of the penis is associated with significant morbidity if early surgical repair is not carried out. A simple same-day surgical technique performed under local anaesthesia is presented that requires no pre-operative investigations. Careful clinical examination (rolling sign) is used to accurately identify the fracture site.
Carotid endarterectomy is performed for symptomatic and asymptomatic carotid disease. The eversio... more Carotid endarterectomy is performed for symptomatic and asymptomatic carotid disease. The eversion carotid endarterectomy is one technique for performing carotid endarterectomy that is gaining popularity. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.
The left retroperitoneal posterior lateral approach for repair of abdominal aortic aneurysms offe... more The left retroperitoneal posterior lateral approach for repair of abdominal aortic aneurysms offers excellent exposure of the subdiaphragmatic aorta and its branches. It is ideal for pararenal, suprarenal, and Type IV thoracoabdominal repairs as well as in patients who are obese and have hostile abdomens or horseshoe kidneys. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.
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