Dave Harnanan

Dave Harnanan
University of the West Indies, St. Augustine | UWI · Department of Clinical Surgical Sciences

About

52
Publications
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311
Citations

Publications

Publications (52)
Article
Full-text available
Urgent carotid endarterectomy (CEA) is beneficial in patients with non-disabling stroke or transient ischemic attack and significant ipsilateral carotid artery stenosis. It is recommended to be performed within 2-4 weeks of the event; however, its safety when done within 48 hours is still under investigation with potential risks of recurrent ipsila...
Article
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Smooth muscle is a normal component of the inferior vena cava (IVC) wall. Although uncommon, the smooth muscle component may undergo neoplastic change. Benign neoplasms are termed leiomyomas, and when there is a malignant change, the nomenclature is changed to an IVC leiomyosarcoma. Leiomyosarcomas of the IVC are rare, with less than 150 cases repo...
Technical Report
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Background: In an attempt to avoid mesh-related complications, many authorities have described non-mesh repair of midline ventral hernias. We described rectus muscle repair (RMR) for ventral hernias in 1993, but we noticed that a limitation was the inability to repair large hernia defects. We now describe a modification of this technique that a...
Chapter
Neuropathic ulcers occur in areas which are subjected to increased pressures due to stress and repetitive injuries. They are seen in a foot that is typically warm, well perfused with bounding pulses in the areas of high pressure such as the plantar surface of the metatarsal heads and the heel of the foot. These ulcers arise in patients who have a n...
Article
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Introduction: This retrospective study investigated major adverse limb events (MALE) and mortality outcomes in critical limb-threatening ischemia (CLTI) patients with tissue loss after an endovascular revascularization-first (EVR-1st) strategy. Methods: MALE and mortality were assessed in 157 consecutive patients with CLTI and tissue loss from J...
Article
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The prevalence of non-healing diabetic foot ulcers in increasing and its management continues to be a challenge with high rates of progression and recurrence. The Achilles tendon in diabetics undergoes microscopic reorganization leading to its shortening. The resulting equinus deformity, combined with neuropathy and arthropathy, may cause pressure...
Article
Objective : We report a case of systemic arterial air embolism (SAAE), complicating the open repair of a ruptured descending thoracic aneurysm and aorto-bronchial fistula, while on cardiopulmonary bypass. Method : A 55-year-old patient was placed on beating heart cardiac bypass, for the open repair of a ruptured type C descending thoracic aneurysm...
Article
Female patients with abdominal aortic aneurysms (AAAs) are usually less common and older than their male counterparts. We report on AAA disease in a Caribbean nation with respect to gender and review their outcomes relative to the male population. Data were collected prospectively and analyzed retrospectively for patients with AAAs who underwent su...
Article
Abstract: Female patients with abdominal aortic aneurysms (AAAs) are usually less common and older than their male counterparts. We report on AAA disease in a Caribbean nation with respect to gender and review their outcomes relative to the male population. Data were collected prospectively and analyzed retrospectively for patients with AAAs who un...
Article
When Henri Hartmann invented his operation in 1921, his intent was not for use in benign disease but as an alternative for Miles’ abdominoperineal resection which, at that period, had a high mortality rate. With advancements in medicine, Hartmann’s procedure was replaced by abdominoperineal resection which had a significant drop in mortality. In th...
Article
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The median arcuate ligament compression syndrome is a rare entity that occurs in 2 per 100,000 unselected individuals. We present a case where the median arcuate ligament compression syndrome was associated with an equally uncommon anatomic variation—a celiac-mesenteric trunk, which occurs in 0.42-2.7% of unselected individuals. We could find no pr...
Article
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The Klippel-Trénaunay syndrome is an unusual syndrome of vascular and dermatologic manifestation in which patients demonstrate hemihypertrophy of the soft tissue and bones of one limb, cutaneous haemangiomas and varicosities in anatomically abnormal positions. Described in 1900 by two French physicians, the etiology remained unclear until recently,...
Chapter
Lipedema is a condition where there is abnormal, increased deposition of adipose tissue in the subcutaneous tissues. This distinct clinical entity was initially described by Allen and Hines, affecting the lower limbs. The longstanding and progressive nature of this disease condition often results in discomfort, pain, and disfiguration, which can af...
Chapter
Deep vein thrombosis (DVT) is a severely debilitating condition, usually originating in the lower limb and pelvis giving rise to the feared complications of pulmonary embolism (PE), a preventable cause of mortality, and the post-thrombotic syndrome (PTS). Approximately two-thirds of patients are admitted with clinical signs of DVT with lower limb e...
Technical Report
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Breast cancer patients often present very late with obvious skin tethering or dimpling. This late presentation is often associated with poor prognosis and bad outcome. Picking up these patients at an earlier stage before any obvious clinical signs and earlier treatment can often offer full cure to some of these patients. We have observed a new sign...
Article
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Skin tethering (ST) is regarded as a classical clinical feature of breast cancer. In many cases, ST is not evident on inspection, arm raising and skin pinching over the lump. We have observed that pushing the lump in one or other direction may elicit skin dimpling that was not otherwise evident. In these cases there is normal fat, grossly and histo...
Article
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Lower extremity amputations and diabetic foot-related complications in the Caribbean population have been previously reported. However, there is a lack of evidence that assess the quality of life experienced in such amputees. This study aimed to determine the health-related quality of life (HRQoL) in patients after a major lower limb amputation. Da...
Article
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Background Acute upper limb ischemia is an uncommon clinical manifestation of thromboembolism seen predominantly in patients with atrial fibrillation. Treatment can be by conservative or surgical means but the consensus is that after conservative treatment, symptoms still persist. In this series, an attempt was made at limb preservation and return...
Article
Full-text available
Major lower extremity amputations have been an area of much concern in the Caribbean population. Hence, the purpose of this research was to investigate the current trends in major lower-extremity amputations. Data regarding all major lower-extremity amputations performed at a tertiary care institution in Trinidad and Tobago, from January 2010 to De...
Article
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Background: Major lower extremity amputation is defined as any amputation of the limb performed above the level of the ankle. Indications often include severe infection, ischemia, trauma and tumours. Total amputation rate in Trinidad and Tobago (T&T) is not yet known. Data is only available from a single center in Trinidad and Tobago over a two yea...
Article
Full-text available
Carotid arterial injuries occur in 5-6% of persons with penetrating trauma. Complete transection is rare in civilian practice and is most often due to penetrating injuries. Complete transection as an iatrogenic complication is rare. We present a case where we were required to repair a complete transection of the carotid artery with segmental loss w...
Article
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We report a near-fatal rectal perforation due to a phosphate en-ema in an elderly male. The presentation in septic shock within 4 hours of the enema is quite rare. Early recognition and prompt management are essential for a good outcome. A defunctioning colostomy is standard for these cases but we recommend a distal rectal washout since intralumina...
Article
Necrotizing fasciitis, commonly known as "flesh-eating disease," is an aggressive soft tissue infection that destroys the fascia, subcutaneous tissue, and skin. Specific clinical features (crepitus or radiologic features of gas in tissues) either appear late or are of poor sensitivity. Thus, a high index of clinical suspicion is required for early...
Preprint
Full-text available
PURPOSE: Lower extremity amputations and diabetic foot-related complications in the Caribbean population have been previously reported [1-3]. However, there is a lack of evidence which assesses the Quality of life experienced in such amputees. The aim of this study was to determine the health-related Quality of life (HRQoL) in patients after a majo...
Article
Full-text available
Trinidad and Tobago (T+T) is a small twin-island state in the Caribbean, eight miles off the coast of Venezuela. It has an area of approximately 5431 square kilometres and population of 1.4 million. At the present time, there are 116 coronavirus disease (COVID-19) cases and eight deaths, with no new cases or deaths for the last 21 days (May 17, 202...
Article
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Background: The Advanced Trauma Operative Management (ATOM) course which is aimed at improving penetrating trauma management skills is very challenging to conduct. We assessed the feasibility and potential impact of ATOM training in Trinidad and Tobago through the University of Toronto Global surgery initiative and its potential for improving penet...
Article
Background: Ulcers in diabetic neuropathic feet are quite common but should be differentiated from the distinctive but rare ulceration due to rat bite in these insensate feet. We describe and analyse the features of rat bites in 2 patients with diabetic neuropathic feet and highlight 8 clinical features that should raise suspicion and alert the cl...
Article
Full-text available
Splenic artery aneurysms (SAAs) are an extremely rare cause of asymptomatic massive lower gastrointestinal bleeding with less than a handful of patients surviving such a presentation. A 24-year-old female presented in shock after multiple epi- sodes of massive rectal bleeding. Imaging revealed a heterogeneous mass arising from the tail of the pancr...
Article
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Introduction Phyllodes tumors (PTs) of the breast are extremely rare accounting for less than 1% of all breast tumors globally. Case records at the Trinidad and Tobago Cancer Registry show that only 0.003% of the reported breast cancer cases between 1995 and 2009 were PTs. Presentation of the case We report a 45-year-old woman who presented with s...
Article
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Giant pheochromocytomas are rare silent entities that do not present with the classical symptoms commonly seen in catecholamine-secreting tumors. In many cases they are accidentally discovered. The algorithm to diagnose a pheochromocytoma consists of biochemical evaluation and imaging of a retroperitoneal mass. The female patient in this case repor...
Article
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Introduction: Pelvic exenteration (PE) is an ultra-radical surgical procedure characterized by the en bloc resection of the pelvic organs. Methods: In this case series, we report retrospectively on four patients who underwent PE in Trinidad and Tobago from 2012 to 2016. One male patient had rectal cancer while one each of three women had cervical,...
Article
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Introduction Malignant melanoma of the heel is a rare melanoma subtype with incidence rates that reflect the complex relationship between sun exposure at certain geographic locations, individual melanin levels and overall melanoma risk. It is oftentimes characterized by poor prognosis because of delays in presentation resulting in longitudinal tumo...
Article
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Cholangiocarcinoma is an uncommon primary malignancy of the biliary tract that is challenging to diagnose and treat effectively due to its relatively silent and late clinical presentation. The present study reports a case of a 60‑year‑old male with distal extrahepatic cholangiocarcinoma with a 3‑week history of painless obstructive jaundice symptom...
Conference Paper
Objectives: To establish that the typical presentation of Abdominal Aortic Aneurysms (AAA) may be challenged with the change in lifestyles in this female population. Design and Methods: Demographic data were collected for patients with AAA who underwent open surgery from 2001 to 2015 and analyzed retrospectively. Results: There were 40 patients, al...
Article
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Background The SEUSA program, the Donation and Transplantation Institute foundation consultancy program, was implemented in Trinidad and Tobago (T&T) in 2010 with the support of the National Organ Transplant Unit (NOTU) and the Ministry of Health of T&T. Methods The SEUSA program included (1) diagnosis of the current situation using the ODDS (Orga...
Article
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Introduction: Brachial artery injuries from elbow dislocations are uncommon, but they may lead to disastrous consequences if the diagnosis is delayed. Presentation of case: We report a case of a patient who sustained a fall onto the elbow, with dislocation and brachial artery injury, despite an ipsilateral radial pulse being palpable. Discussion:...
Article
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Isolated endometriosis of the intestine causing large bowel obstruction is rare. We present a case of endometriosis presenting as large bowel obstruction in a woman of childbearing age. She had no previous symptoms to suggest endometriosis and on presentation urgent surgery was required. The diagnosis of endometriosis was made only after pathologic...
Article
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Myolipoma of soft tissue is an extremely rare benign lipomatous lesion. The lesions are most commonly located in the abdominal cavity, retroperitoneum, and inguinal areas. Despite their large size, myolipomas are cured by surgical resection. We present the case of a 79 year-old man who presented with bilateral reducible inguinal hernias (right larg...
Article
Full-text available
Extrauterine leiomyomas are rare, benign, and may arise in any anatomic sites. Their unusual growth pattern may even mimic malignancy and can result in a clinical dilemma. Occasionally, uterine leiomyomas become adherent to surrounding structures. They also develop an auxiliary blood supply, and lose their original attachment to the uterus, thus be...
Article
To determine if there is a beneficial effect of bariatric surgery in the management of Diabetes Mellitus in obese patients in a Caribbean setting. 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...
Article
To investigate the strategy of malrotation of the midgut encountered during laparoscopic gastrointestinal surgery. A 37 year old morbidly obese male (body weight=140 kg, BMI>65), presented with complaints of severe lower back pain and significant sleep apnea. After thorough pre-operative assessment, the patient was scheduled for a LRYGB procedure....
Article
This study examines the perioperative outcome of laparoscopic splenectomy in a minimal resources setting in the Caribbean. Seventeen consecutive patients who underwent elective laparoscopic splenectomies by a single surgeon from August 2003 to December 2008 were studied. Data collected included patients' demographics, indications for surgery, opera...
Article
Splenic cysts are relatively uncommon entities in surgical practice and treatment options vary. We present a case of a young adult woman who presented with a left-sided abdominal mass. A large splenic cyst was diagnosed by abdominal ultrasound and computed tomography. Laparoscopic partial excision with marsupialisation was performed with uneventful...
Article
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We report a case of a 6-year-old girl suffering from morbid obesity, Blount;s disease, and significant social and functional impairment who underwent a laparoscopic sleeve gastrectomy. One year later, she has shown remarkable improvement in all aspects of her health emphasizing the success of the procedure. A follow-up laparoscopic Roux-en-Y gastri...
Article
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. This study outlines the experiences associated with 619 laparoscopic cholecystectomies performed in Trinidad. The records of 619 cons...
Article
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. Strict measures were taken to minimize the operating times and duration of pneumoperitoneum in SCD patients undergoing LC...

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