External Fixators ; Female ; Femoral Fractures - diagnostic imaging Femoral Fractures - surgery ; Femoral Fractures - therapy ; Fracture Fixation, Internal - methods ; Fracture Fixation, Intramedullary - methods ; Fracture Healing - physiology

Although isolated cranial nerve palsies are common in diabetic patients, multiple, simultaneous cranial neuropathies are rare. We describe the second case of a complete superior orbital fissure syndrome including the optic nerve in a middle-aged Papuan man with newly diagnosed diabetes mellitus. The differential diagnosis included septic cavernous sinus thrombosis and Tolosa Hunt syndrome, and management was initially directed at excluding these serious, treatable conditions.
Cavernous Sinus Thrombosis - diagnosis ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - diagnosis ; New Guinea ; Oculomotor Nerve Diseases - diagnosis ; Oculomotor Nerve Diseases - etiology ; Tolosa-Hunt Syndrome - diagnosis

Trauma is a leading cause of admissions to the surgical ward in Papua New Guinea (PNG), accounting for about 35% of cases. Of these, 15% of cases are abdominal injuries, of which 19% are penetrating injuries. Selective surgical management of patients with a low-velocity anterior abdominal wound (AAW) is beneficial in some patients. AIM: To determine if selective surgical management is a viable therapeutic option in PNG. METHODS: A non-random prospective study of consecutive cases was done on 60 patients with an AAW based entirely on clinical symptoms and signs. The outcome measures were length of hospital stay, morbidity and mortality. Data were analysed using SPSS 10.0 for Windows and Microsoft Excel. RESULTS: Immediate laparotomy was done on 24 (40%) of cases and 36 (60%) had nonoperative conservative management, of which 6 (17%) failed and went on to have laparotomy on demand. The average hospital stay was 4 days shorter (p = 0.0001) for the nonoperative group, which had significantly fewer complications (p = 0.01). No deaths were recorded in either of the two groups of patients. CONCLUSION: Selective nonoperative management of stable patients with an AAW with or without omental signs is a safe therapeutic option in PNG.
Abdominal Injuries/complications/mortality/*surgery ; Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Laparotomy ; Length of Stay/statistics & numerical data ; Male ; Papua New Guinea ; Patient Selection ; Peritonitis/etiology/*surgery ; Prospective Studies ; Treatment Outcome ; Wounds, Penetrating/complications/mortality/*surgery ; Young Adult

A case is presented of acute spinal cord compression by a thoracic dumbbell spinal schwannoma in a young woman with neurofibromatosis type 1 (NF-1). A successful outcome was achieved with total excision of the lesion and decompression of the spinal cord. Greater recognition of the reversibility of spinal cord compression in the developing world is necessary to reduce major permanent morbidity.
Adult ; Female ; Human ; Neurilemmoma - complications ; Neurilemmoma - surgery ; Spinal Cord Compression - etiology

PIP: By mid-1995, a total of 308 HIV cases had been reported in Papua New Guinea. The majority (74%) of these cases were diagnosed in Port Moresby. This article describes the clinical characteristics of HIV infection in 67 adults who presented to Port Moresby General Hospital in 1990-95. The median age at presentation was 27 years in men and 28 years in women, with an equal distribution of cases by sex. The major presenting symptoms were wasting and weight loss exceeding 10% of body weight (94%), chronic diarrhea (47%), prolonged fever (77%), and oropharyngeal candidiasis (66%). Pulmonary tuberculosis was diagnosed on the basis of chest X-ray and history in 37 patients (56%), but only 3 had sputum positive for acid-fast bacilli. Anemia was present in 75%. 65 patients (97%) fulfilled the World Health Organization criteria for AIDS. The inpatient mortality rate in this series was 43%, and 13 of these 29 patients died within a month of their first presentation.
Acquired Immunodeficiency Syndrome - diagnosis ; Acquired Immunodeficiency Syndrome - epidemiology ; HIV Infections - diagnosis ; HIV Infections - epidemiology ; Humans ; Papua New Guinea - epidemiology ; Risk Factors