Treatment of low rectal carcinoma by transanal electrocoagulation

This study reports the first 13 cases of biopsy-proven low rectal carcinoma treated by transanal electrocoagulation using a locally manufactured instrument. At the University Hospital of the West Indies, over a 16-year period, 9 patients were treated for cure, six of whom have no clinical evidence of recurrence for one to 12 years. Four cases who were offered this procedure for palliation defaulted after a single treatment. Transanal electrocoagulation provides an additional option for treating patients with small, mobile low rectal cancers, following careful screening for evidence of nodal or distant spread. The procedure can also be used in the local control of disease in patients with distant spread or in whom a major operation is not feasible (AU)

Absence of Escherichia coli 0157 in a survey of wildlife from Trinidad and Tobago

Fecal, cloacal, or rectal swabs of free-ranging and captive mammalian and avian wildlife in Trinidad and Tobago were cultured for non-sorbitol fermenting Escherichia coli and tested for 0157: H7 strains. Ability of E. coli strains to produce hemolysin and mucoid colonies also was investigated. Of 271 free-ranging mammals tested, 158 (58 percent) yielded E. coli; only one (< 1 percent) bacterial isolate was a non-sorbitol fermenter which was not agglutinated by 0157 antiserum. All isolates were negative for hemolysin production and mucoid colonial growth. Two hundred and sixty-three (90 percent) of 293 free-flying birds were positive for E. coli and all isolates were sorbitol fermenters and negative for production of hemolysin and mucoid growth. Of 175 captive wild animals from individual backyard farms and a government demonstration farm, 145 (83 percent) yielded E. coli with four (2 percent) non-sorbitol fermenters; all were negative for 0157 strains, hemolysin production, and mucoid colonial growth. Of 373 animals in a zoo, 250 (67 percent) were positive for E. coli with only two (0.5 percent) non-sorbitol fermenters. All strains were non-hemolytic and non-mucoid farms. It appears that free-ranging and captive avian and mammalian wildlife are not important reservoirs of 0157: H7 stains of E. coli in Trinidad and Tobago.(AU)

Pancolo-mucosal proctectomy with ileo-anal anastomosis - abstract

Preservation of the ano-rectal spinchter and lower rectal muscle cuff following total colectomy and a mucosal protectomy with ileo-anal anastomosis (CMP - IAA) effectively removes all the debilitating, potentially malignant colonic mucosa and results in good to excellent continence. Since 1983 at U.H.W.I., Mona, five (5) patients have undergone CMP - IAA for colonic mucosal dysplasia and multicentric adenocarcinoma (1), familial polyposis coli (1), juvenile polyposis coli (1) and ulcerative colitis (2). Four out of five have had clousure of their temporary diverting ileostomy and all have good to excellent anal continence, with an average of 2 - 6 stools/day. There were no deaths and an unremarkable post-operative course was noted in all except one patient with over a 20-year history of steriod-controlled ulcerative colitis. She had a prolonged stormy post-operative course, rectal cuff abscess and resulting ileo-anal stricturing. Not withstanding this, she has good anal continence, but requires digital dilation. This initial experience of the U.H.W.I. group compares favourably with over 2,500 cases in the current literature and establishes CMP - IAA as the procedure of choice in this group of young, active patients (AU)

Ruptured rectal prolapse

Rectal prolapse is not a common surgical disorder. The complication reported here, of evisceration of small bowel through a prolapsed rectum, is extremely rare and is the first case reported in the West Indies. Some of the features of rectal prolapse are described, and the surgical management of this particular complication is discussed (AU)

Amoebiasis in Jamaica

Amoebiasis still occurs in Jamaica. This paper describes the unexpected occurrence of the disease in three adult males, two with colitis and the other with an hepatic abscess. This, to our knowledge, is the first report of amoebiases in Jamaica for over two decades and serves to underscore the continued need for the inclusion of amoebiases in the differential diagnosis of unexplained hepato-intestinal disease (AU)

Fibrosarcoma of the vulva: case reports and discussion

Three cases of fibrosarcoma of the vulva are reported. In two, surgical resection resulted in remission over four years. In the third case, presenting with metastasis of the lung and liver, the patient died without surgery been carried out. The low mitotic index found in the first two cases seems to lead to a favourable prognosis, whereas the inferior vulvar localization found in the last case seems to be more dangerous because its diffusion into the paravaginal space

Outbreak of typhoid fever in Trinidad in 1971 traced to a commercial ice cream product

In April 1971, a nationwide outbreak of typhoid fever involving 132 persons occurred in Trinidad; there were no deaths. Eighty per cent of cases occurred in children ages 5-14, and more than 90 percent of ill persons lived or went to school in the main towns or in smaller communities along their connecting roads. The epidemic curve suggested a common source, and a series of food preference questionaires implicated a nationally distributed ice cream product. Further investigation indicated that the product was distributed on only one day, March 23. The mean incubation period was 19 days, and the attack rate for those at risk was slightly greater than 1 percent. Samples of the ice cream product obtained a month after the outbreak were found to contain greater than 1100 Escherichia coli per 100 ml. Inspection of the plant revealed frequent hand contact with the product and an absence of pasteurization facilities. Although rectal swabs and stool cultures obtained after purgation from employees failed to identify the carrier, epidemiologic evidence suggested that an employee in the plant, rather than a contaminated ingredient, was the source of the outbreak. This outbreak emphasizes the need for mandatory pasteurization of milk and ice cream products, especially when strict sanitary procedures cannot be adhered to or enforced (AU)

Clinical gonorrhea in the female: laboratory findings

This paper is very timely in its relationship to the current epidemic of gonorrhea in this country and as reported by the western nations. It emphasizes the difficulty in establishing the diagnosis of gonorrhea in women and girls without using cultures from the cervix and rectum. The new media soon available to the practising profession will be a boon in this regard. Mixed infections or infestations have been proven in instances of vaginitis. The smear is of little value alone. This study does not touch upon the high percentage of women infected with gonorrhea who are asymptomatic. (AU)

Influence of malnutrition on the body temperature of children

The mean auricular temperature of 10 malnourished Jamaican infants was 0.84§C lower on admission to hospital than it was after recovery. Body temperature was influenced by ambient temperature in the malnourished state. During the rapid growth that accompanies recovery the mean auricular temperature was raised. Five malnourished children with hypothermia were given a standard high-calorie feed, and this caused the body temperature to return to normal levels within two hours in every case. These results suggested that reduced temperature in malnourished children may be an adaptation to conserve calories, and that severe hypothermia in malnutrition results from an acute shortage of energy reserves. Frequent feeding of malnourished chhildren is most important in their management. (Summary)

Spontaneous rupture of the distal large bowel

Six new cases of spontaneous rupture of the normal distal large bowel are described and 19 cases from the literature are reviewed, bringing the total of the recorded cases to 25. The aetiology of these cases is discussed. The ruptures occur in the region of the pelvi-rectal junction, in the sigmoid loop, and in the upper rectum. The tear is considered to be mechanical in origin and to be due to a sudden rise in intraluminar pressure which results from sudden obstruction during active peristalsis. Rupture may occur quite spontaneously but is more likely to occur in the presence of constipation and during def‘cation. The diagnosis, treatment, and mortality are also discussed. (Summary)

Barium studies in intestinal lymphogranuloma venereum

The radiological appearance of the colon and rectum in lymphogranuloma venereum in a study of 144 cases treated in the University College Hospital of the West Indies, are described and illustrated. The extent of the disease can be assessed only by a barium enema examination. The colon is always affected in the stage of proctocolitis and often in the structure stage. (AU)

Rectal lymphogranuloma venereum in Jamaica

The clinical features of rectal lymphogranuloma venereum are described. The 91 cases of rectal lymphogranuloma have been studied at the University College Hospital of the West Indies since 1953. The pathogenisis of the disease is discussed and some doubts are expressed about the commonly accepted theory. The Complement Fixation Test appears to be no guide to the efficacy of treatment. The antibiotics are effective in producing a clinical cure of the disease in over 70 percent of cases, and have a beneficial effect even on the cases of established stricture. Radical surgery is used in cases of severe stricturing,"Esthiomene" or with recto-vaginal fistulae. Other forms of treatment have been used, being ineffective and occasionally dangerous