At otal of 675 consecutive patients who underwent primary total hip replacement in ar egional orthopaedic centre in the South West of Britain were recruited prospectively. RESULTS The median length of stay was 8d ays. The majority of patients (81.5%) left hospital within 2w eeks, 13.6% within 2-4 weeks and 4.9% after 4w eeks. On multivariate analysis, age above 70 years, ASA grades 3a nd 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2w eeks. ORTHOPAEDICSCONCLUSIONS Prolonged stay after THA is largely predetermined by case mix and this should be taken into account when units are compared for performance and in the remuneration they receive for providing this service. Slick surgery through limited incisions may reduce the length of stay.

Objective: To examine the perceptions of body size among adolescents in Trinidad and to determine whether there were ethnic differences. Design: Cross-sectional survey. Setting: Secondary schools in Trinidad. Subjects: A stratified random sample of 1139 adolescents, aged 14 -17 y. Measurements: Silhouettes of different body sizes were used to determine perceptions of body size, while weights and heights were measured to determine actual body size. Results: A total of 1090 students (96% response rate) participated, comprising 578 (53%) females. The main ethnic groups were South Asian (49%), African (25%) and persons of mixed ethnicity (23%). The calculated body mass index (BMI) indicated that 14% were thin, 73% normal and 13% overweight; however there was a preponderance of thinness among South Asian males (28%). Whereas 68% of students correctly identified their body size, South Asian males were also more likely to overestimate their body size than the other adolescents, ie they were thinner than they thought. Overall, 64% of the sample was satisfied with their current size, but thin South Asians were more likely to be satisfied with their size than other thin adolescents (P ¼ 0.04), while overweight Africans were more likely to be satisfied than other overweight persons (P ¼ 0.03). The majority of the sample associated the normal body size with good health, but the majority also associated the overweight and obese silhouettes with wealth. In addition, 40% of them associated the male overweight and obese silhouettes with happiness. Conclusion: Although the prevalence of overweight=obesity was not high, the perception of the Trinidadian adolescent that obesity was associated with wealth, and to a lesser extent happiness, and the satisfaction of the overweight African females with their size, were all causes for concern.

Patient: Male, 26Final Diagnosis: Marihuana addictionSymptoms: Compulsive showering • nausea • vomitingMedication: —Clinical Procedure: —Specialty: ToxicologyObjective:Unexpected drug reactionBackground:The use or misuse of Cannabis is well recognized in the Caribbean region. Recently, the cannabinoid hyperemesis syndrome has been described. The triad is characterized by chronic marijuana use, cyclical vomiting, and compulsive bathing. With the extensive use to marijuana as a recreational drug and also the increased use as prescription medication, a patient presenting with this symptomatology needs to be assessed appropriately and this syndrome needs to be one of the differential diagnoses.Case Report:To our knowledge, we report the first such case in the Caribbean region. Here, we report on the case of a 26-year-old Caucasian male with a 3-week history of nausea and week of epigastric pain and vomiting. The patient was known to use marijuana daily for 2 years and had similar complaints for the last 6 months.Conclusions:Because this popular recreational drug is now being used with increased frequency as a prescribed medication, it is crucial that clinicians be aware of this condition, which can present as a diagnostic dilemma.

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