Objective: Venous insufficiency is a prevalent and potentially debilitating disease. Treatment guidelines and techniques such as radiofrequency ablation (RFA) developed in the United States and Europe have been shown to provide significant improvements in quality of life; however, these have not been clearly assessed in the populations of developing nations. This study examined quality of life outcomes after RFA of patients treated at a single Jamaican vein center. Methods: In this study, 100 patients who underwent RFA from 2007 to 2012 were evaluated. Patients answered the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) questionnaire assessing quality of life before and after RFA. Improvements in specific categories, such as venous symptoms, work limitations, social limitations, and cosmetic concerns, were evaluated. Cumulative VEINES-Sym and VEINES-QOL scores were also assessed. Results: Patients' quality of life responses were significantly improved in every individual VEINES question. Average cumulative VEINES-Sym t score improved 9.96 points (P <.01), and VEINES-QOL t score improved 11.15 points (P <.01). For patients with Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) C5 and C6 disease, the only questions that did not show significant improvement were limitations to daily workplace activity and impact on clothing after RFA. However, in this subset, the average VEINES-Sym t score improved 11.83 points (P <.01), and the VEINES-QOL t score improved 11.96 points (P <.01) after RFA. Conclusions: Venous disease is often overlooked, and access to treatment can be limited in developing nations. This study demonstrated that venous treatment guidelines and RFA techniques developed in the United States and Europe could be successfully applied to a Jamaican population, resulting in significant improvements in quality of life.

INTRODUCTION:By providing a structured forum to exchange information and ideas, multidisciplinary team meetings improve working relationships, expedite investigations, promote evidence-based treatment, and ultimately improve clinical outcomes.METHODS:This discursive paper reports the introduction of a multidisciplinary team approach to manage hepatobiliary diseases in Jamaica, focusing on the challenges encountered and the methods used to overcome these obstacles.CONCLUSION:Despite multiple challenges in resource-limited environments, a multidisciplinary team approach can be incorporated into clinical practice in developing nations. Policy makers should make it a priority to support clinical, operational, and governance aspects of the multidisciplinary teams.

The Authors regret that the below text on page 823 of the above article was incorrect. ‘Two radiologists independently reviewed 309 CT angiographic studies performed over 2 years between 1 July 2010 and 30 June 2012 at a regional hepatobiliary referral centre for the Northern Caribbean.’ The sentence should have read as below, ‘Two radiologists independently reviewed 309 CT scans studies performed over 2 years between 1 July 2010 and 30 June 2012 at a regional hepatobiliary referral centre for the Northern Caribbean.’ Variants of hepatic arterial supply in a Caribbean population: A computed tomography based studyClinical RadiologyVol. 68Issue 8PreviewTo evaluate the spectrum of hepatic arterial variants in unselected patients undergoing computed tomography (CT) of the abdomen at the main regional referral centre in the northern Anglophone Caribbean. Full-Text PDF

AIM: To evaluate the spectrum of hepatic arterial variants in unselected patients undergoing computed tomography (CT) of the abdomen at the main regional referral centre in the northern Anglophone Caribbean.MATERIALS AND METHODS: Two radiologists independently reviewed 309 CT angiographic studies performed over 2 years between 1 July 2010 and 30 June 2012 at a regional hepatobiliary referral centre for the Northern Caribbean. The anatomical variations were described according to a conventional classification proposed by Michels et al.RESULTS: In this Caribbean population, the majority of patients had conventional Michels' type 1 vascular anatomy (63.4%). However, a statistically significantly greater incidence of Michels' type 2 variations (20.4%) were found than that reported in the international literature and a lower incidence of type 3 (5.2%), type 6 (0.6%), and type 9 (0) patterns than previously reported. One case with variations not previously described in this classification was also encountered.CONCLUSION: Although 63.4% of persons in a Caribbean population have conventional vascular anatomy, the distribution of anatomical variants is quite different to that seen in North American and European centres. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity and mortality during invasive procedures. (C) 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

In the classic description of hepatic arterial supply, the common hepatic artery originates from the coeliac trunk. However, there are numerous variations to this classic pattern. We report a rare variant pattern of hepatic arterial supply and discuss the clinical significance of this variation.

In an era of technology-dependent surgery, Jamaica and other developing countries must deal with the wide disparity between their surgical practices and those of developed nations. Although there is still a place for the well-trained surgeon, the current emphasis in developed nations is less on the individual surgeon and more on the surgery team and system, with increasing costs despite diminishing government support. At the University of the West Indies, we are challenged to continue providing appropriate service and training for the Caribbean region, but we hope that a combination of fellowship-trained team leaders and partnerships with resource-rich institutions will enable us to meet this challenge and to meet the health care needs of our populace.

Duplication cysts represent one of many congenital abnormalities of the gastrointestinal tract. It is an uncommon cause of acute abdominal pain but remains a consideration in the pediatric population. To highlight aspects of the disease and the value of exploratory laparotomy in pediatric patients with recurrent abdominal pain, we present the case of a patient who was admitted to hospital several times for recurrent abdominal pain in whom we eventually diagnosed intestinal duplication.