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Hepatic grooves:An observational study at laparoscopic surgery

World Journal of Experimental Medicine 2024年第2期14卷 97-102页

作者： Shamir O Cawich Dexter A Thomas Fawwaz Mohammed Michael T Gardner Marlene Craigie Shaneeta Johnson Ramnanand S Kedambady Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago Section of Anatomy Basic Medical SciencesUniversity of the West IndiesKingston 000000Jamaica Department of Radiology University of the West IndiesKingston 000000Jamaica Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Section of Anatomy Department of Basic Medical SciencesUniversity of the West IndiesKingston KIN7Jamaica

BACKGROUND In traditional descriptions,the upper surface of the liver is smooth and convex,but deep depressions are variants that are present in 5%-40%of patients.We sought to determine the relationship between surface depressions and the diaphragm.AIM To use exploratory laparoscopy to determine the relationship between surface depressions and the diaphragm.METHODS An observational study was performed in all patients undergoing laparoscopic upper gastro-intestinal operations between January 1,2023 and January 20,2024.A thirty-degree laparoscope was used to inspect the liver and diaphragm.When surface depressions were present,we recorded patient demographics,presence of diaphragmatic bands,rib protrusions and/or any other source of compression during inspection.RESULTS Of 394 patients,343 had normal surface anatomy,and 51(12.9%)had prominent surface depressions on the liver.There was no significant relationship between the presence of surface depressions and gender nor the presence of rib projections.However,there was significant association between the presence of surface depressions and diaphragmatic muscular bands(P<0.001).CONCLUSION With these data,the diaphragmatic-band theory has gained increased importance over other theories for surface depressions.Further studies are warranted using cross sectional imaging to confirm relationships with intersectional planes as well as beta-catenin assays in the affected liver parenchyma.

关键词： Liver Variant Vein Hepatic Surgery

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A CFD Model to Evaluate Near-Surface Oil Spill from a Broken Loading Pipe in Shallow Coastal Waters

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Fluid Dynamics & Materials Processing 2024年第1期20卷 59-77页

作者： Portia Felix Lee Leon Derek Gay Stefano Salon Hazi Azamathulla Department of Civil and Environmental Engineering The University of the West IndiesSt.AugustineTrinidad and Tobago National Institute of Oceanography and Experimental Geophysics-OGS TriesteItaly

Oil spills continue to generate various issues and concerns regarding their effect and behavior in the marine environment,owing to the related potential for detrimental environmental,economic and social implications.It is essential to have a solid understanding of the ways in which oil interacts with the water and the coastal ecosystems that are located nearby.This study proposes a simplified model for predicting the plume-like transport behavior of heavy Bunker C fuel oil discharging downward from an acutely-angled broken pipeline located on the water surface.The results show that the spill overall profile is articulated in three major flow areas.The first,is the source field,i.e.,a region near the origin of the initial jet,followed by the intermediate or transport field,namely,the region where the jet oil flow transitions into an underwater oil plume flow and starts to move horizontally,and finally,the far-field,where the oil re-surface and spreads onto the shore at a significant distance from the spill site.The behavior of the oil in the intermediate field is investigated using a simplified injection-type oil spill model capable of mimicking the undersea trapping and lateral migration of an oil plume originating from a negatively buoyant jet spill.A rectangular domain with proper boundary conditions is used to implement the model.The Projection approach is used to discretize a modified version of the Navier-Stokes equations in two dimensions.A benchmark fluid flow issue is used to verify the model and the results indicate a reasonable relationship between specific gravity and depth as well as agreement with the aerial data and a vertical temperature profile plot.

关键词： CFD model Navier-Stokes equations projection method water surface oil spill shallow coastal waters

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Sacrificial piles as a countermeasure against local scour around underwater pipelines

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Water Science and Engineering 2024年第2期17卷 187-196页

作者： Forough Raeisi Seyed Mohammad Ali Zomorodiann Masih Zolghadr Hazi Mohammad Azamathulla Department of Water Engineering Shiraz UniversityShiraz ***Iran Department of Water Sciences Engineering Jahrom UniversityJahrom ***Iran Department of Civil and Environmental Engineering The University of the West IndiesSt.Augustine CampusTrinidad 331310Republic of Trinidad and Tobago

Local scour around pipelines crossing rivers or in marine environments is a significant concern.It can lead to failure of the pipelines resulting in environmental side effects and economic losses.This study developed an experimental method to reduce local scour around pipelines with a steady flow of clear water by installing cylindrical and cubical sacrificial piles.Three sizes of sacrificial piles were examined in a linear arrangement.Sacrificial piles were installed on the upstream side of the pipeline at three distances.Maximum scour depth reduction rates below the pipeline were computed.The results showed that sacrificial piles could protect a pipeline from local scour.A portion of scoured sediment around the sacrificial piles was deposited beneath the pipeline.This sediment accumulation reduced the scour depth beneath the pipeline.Analysis of the experimental results demonstrated that the size of piles(d),the spacing between piles,and the distance between the pipe and piles(Xp)were the variables that reduced the maximum scour beneath the pipeline with a diameter of D.For the piles with d=0.40D and 0.64D,X_(p)=4OD was the optimal distance to install a group of piles,and cubical piles could mitigate scour more effectively than cylindrical piles under similar conditions.For the piles with d=D,the greatest reduction in scour depth was achieved at X_(p)=50D with any desired spacings between piles,and cylindrical piles in this dimension could protect the pipeline against scour more effectively than cubical piles.

关键词： Clear water River crossing pipeline Local scour Self-burial process Sediment transport

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Colorectal resections for malignancy: A pilot study comparing conventional vs freehand robot-assisted laparoscopic colectomy

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World Journal of Clinical Cases 2024年第3期12卷 488-494页

作者： Shamir O Cawich Joseph Martin Plummer Sahle Griffith Vijay Naraynsingh Department of Surgery University of the West IndiesSt AugustineTrinidad and Tobago Department of General Surgery and Consultant General and Colorectal Surgeon Department of SurgeryUniversity of the West IndiesKingstonKIN7Jamaica Department of Surgery Queen Elizabeth HospitalBridgetownBarbados Department of Surgery Port of Spain General HospitalPort of SpainTrinidad and Tobago

BACKGROUND Laparoscopic colectomy is widely accepted as a safe operation for colorectal cancer,but we have experienced resistance to the introduction of the FreeHandffrobotic camera holder to augment laparoscopic colorectal surgery.AIM To compare the initial results between conventional and FreeHandffrobot-assisted laparoscopic colectomy in Trinidad and Tobago.METHODS This was a prospective study of outcomes from all laparoscopic colectomies per-formed for colorectal carcinoma from November 29,2021 to May 30,2022.The following data were recorded:Operating time,conversions,estimated blood loss,hospitalization,morbidity,surgical resection margins and number of nodes har-vested.All data were entered into an excel database and the data were analyzed using SPSS ver 20.0.RESULTS There were 23 patients undergoing colectomies for malignant disease:8(35%)FreeHandff-assisted and 15(65%)conventional laparoscopic colectomies.There were no conversions.Operating time was significantly lower in patients under-going robot-assisted laparoscopic colectomy(95.13±9.22 vs 105.67±11.48 min;P=0.045).Otherwise,there was no difference in estimated blood loss,nodal harvest,hospitalization,morbidity or mortality.CONCLUSION The FreeHandffrobot for colectomies is safe,provides some advantages over conventional laparoscopy and does not compromise oncologic standards in the resource-poor Caribbean setting.

关键词： Laparoscopic Colectomy Robot Surgery Minimally invasive

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Liver surface depressions in the presence of diaphragmatic muscular bands on trans-illumination

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World Journal of Experimental Medicine 2024年第2期14卷 5-10页

作者： Shamir O Cawich Michael T Gardner Ramanand Shetty Jean Pierre Louboutin Zenica Dabichan Shaneeta Johnson Department of Surgery University of the West IndiesSt AugustineTrinidad and Tobago Section of Anatomy Department of Basic Medical SciencesUniversity of the West IndiesKingston KIN7Jamaica Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States

Traditional descriptions of liver anatomy refer to a smooth,convex surface contacting the diaphragm.Surface depressions are recognized anatomic variants.There are many theories to explain the cause of the depressions.... 详细信息

关键词： Liver Anatomy Depressions Fissure Groove Sulcus Variant

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Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 681-688页

作者： Shamir O Cawich Elijah Dixon Parul J Shukla Shailesh V Shrikhande Rahul R Deshpande Fawwaz Mohammed Neil W Pearce Wesley Francis Shaneeta Johnson Johann Bujhawan Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Faculty of MedicineUniversity of CalgaryCalgaryAlberta T2N2T9Canada Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgical Oncology Tata Memorial CenterHomi Bhabha National UniversityMumbai 400012India Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom university Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Department of Surgery General Hospital in Port of SpainPort of Spain 000000Trinidad and Tobago

BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for complications.The ability to rescue patients from post-PD complications is as a recognized quality measure.Tailored protocols were instituted at our low volume facility in the year 2013.AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality.METHODS A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1,2013 and June 30,2023.Stan-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD complications.RESULTS Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this facility.Major complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their complication.Four(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring PD.Despite low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major complications.We attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protocols.

关键词： Pancreas Complication Rescue Failure Morbidity Mortality Pancreaticoduodenectomy

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Wind and Water: How Extreme Weather Conditions Impact Residential Real Estate in Developing Countries

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International Journal of Disaster Risk Science 2023年第5期14卷 813-821页

作者： Nekeisha Spencer Department of Economics University of the West Indies MonaKingstonJamaica

The damaging effects of extreme weather is concerning for many countries across the globe.Though the impact of these events on the housing market has been studied extensively,one aspect that remains unexplored is the value of mortgages.Further,there is no clarity on the impact of the specific types of homes.This study analyzed mortgages and apartment values and included residential land sale prices over 16 years for different localities across Jamaica.The analysis revealed that mortgages are adversely affected by excess rainfall while apartment sale prices are reduced by hurricanes but increased by excess rain.However,residential land prices remain unaffected by both events.The results point to the importance of climate adaptation for the local real estate market and property investment.

关键词： Excess rainfall Hurricanes Jamaica Residential real estate

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International Journal of Ophthalmology(English edition) 2022年第11期15卷 1791-1797页

作者： Valence A Jordan Lizette L Mowatt Kingston Public Hospital North StKingstonJamaica Department of Surgery University Hospital of the West IndiesJamaica

AIM: To determine the vision-related quality-of-life of glaucoma patients and the association between clinical and socioeconomic factors, and vision-related quality-of-life.METHODS: This was a cross-sectional study. Consecutive patients with glaucoma were interviewed using a modified 25-item National Eye Institute Visual Function Questionnaire(VFQ-25) by a single interviewer. Statistical analysis was done to find associations between patient variables and vision-related quality-of-life scores. Confidentiality and anonymity were maintained.RESULTS: Ninety-six participants were recruited in the study. There were 44 males and the mean age for males and females was 65.7 and 69.5y, respectively. The mean composite score was 71.2(with a maximum possible score of 100), with the highest mean score in the colour vision subscale(89.8) and the lowest mean score in the driving subscale(34.0). Worse visual acuity(P<0.001), longer duration of glaucoma(P<0.001) and higher number of glaucoma medications(P<0.001) were associated with a worse composite score. Female participants and those who lived in urban areas had significantly better scores than male participants(P=0.002) and those who lived in rural areas(P=0.017), respectively.CONCLUSION: The vision-related quality-of-life in Jamaican glaucoma patients is comparable to that of glaucoma patients in the Barbados Eye Study and other international studies using the VFQ-25 questionnaire. Worse quality-of-life scores are associated with poorer visual acuity, longer duration of glaucoma, more glaucoma medications, and sociodemographic factors such as male gender and rural residence.

关键词： glaucoma health-related quality-of-life Jamaica life quality vision

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Primary epithelial tumours of the appendix in a black population:A review of cases

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World Journal of Gastroenterology 2009年第12期15卷 1472-1474页

作者： Rondell Patrell Darrell Graham Nadia Patricia Williams Kamille Aisha west Department of Pathology University Hospital of the West Indies MonaKingston 7JamaicaWest Indies

AIM:To determine the prevalence,histologic types and clinical features of primary epithelial tumours of the vermiform appendix in a predominantly black population.METHODS:All cases of primary tumours of the appendix identified by review of the histopathology records at the university of the west indies between January 1987 and June 2007 were selected.Relevant pathologic and clinical data were extracted with supplementation from patient charts where available.Non-epithelial tumours were excluded.The total number of appendectomy specimens over the period was also ascertained.RESULTS:Forty-two primary epithelial tumours were identified out of 6 824 appendectomies yielding a prevalence rate of approximately 0.62%.Well- differentiated neuroendocrine cell tumours(carcinoids,47.6%)and benign non-endocrine cell tumours(adenomas,45.2%)were most common with nearly equal frequency.The median age was 43 years,with no sex predilection.Carcinoid tumours occurred in younger patients(mean age 32 years),with a male-to-female ratio of 1.2:1.A clinical diagnosis of acute appendicitis was the most common reason for appendectomy(57.1%)and was histologically confirmed in 75%(18 of 24)of cases.In total,16.7%of cases were diagnosed after incidental appendectomy.CONCLUSION:Appendiceal epithelial tumours arerare in our experience,and are represented principally by carcinoid tumours and adenomas.Carcinoid tumours occurred in younger patients but were slightly more common in men than women.Tumours were not suspected clinically and were diagnosed incidentally in specimens submitted for acute appendicitis supporting the need for histological evaluation in all resection specimens.

关键词：上皮肿瘤原发性肿瘤案件人口黑人急性阑尾炎神经内分泌阑尾切除术

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Role of oral antibiotics for prophylaxis against surgical site infections after elective colorectal surgery

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World Journal of Gastrointestinal Surgery 2017年第12期9卷 246-255页

作者： Shamir O Cawich Sachin Teelucksingh Samara Hassranah Vijay Naraynsingh Department of Clinical Surgical Sciences University of the West IndiesSt.Augustine CampusTrinidad and TobagoWest Indies

Over the past few decades, surgeons have made many attempts to reduce the incidence of surgical site infections(SSI) after elective colorectal surgery. Routine faecal diversion is no longer practiced in elective colonic surgery and mechanical bowel preparation is on the verge of being eliminated altogether. Intravenous antibiotics have become the standard of care as prophylaxis against SSI for elective colorectal operations. However, the role of oral antibiotics is still being debated. We review the available data evaluating the role of oral antibiotics as prophylaxis for SSI in colorectal surgery.

关键词： Colorectal Anastomosis Leak Antibiotics Bowel preparation

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