The incidence of primary malignant bone tumors in Suriname

In a retrospective research the incidence of primary malignant bone tumors in Suriname is recorded. In the period 1978 up to and including 1987 there were 15 patients with primary malignant bone tumors, 9 men and 6 women. The incidence is 0.4 per 100.000 per year and for men and women 0.5 and 0.3 respectively. It may be concluded that with the occurrence of 1 to 2 cases per year, these primary bone tumors are rare in Suriname......(AU)

The painful crisis of homozygous sickle cell disease: clinical features

The details of onset, perceived precipitating factors, associated symptoms, and pain distribution in the painful crisis of homozygous sickle cell (SS) disease have been prospectively recorded in 183 painful crises in 118 patients admitted to a day-care centre in Kingston, Jamaica. Painful crises developed most frequently between 3 p.m. and midnight, most commonly affected patients aged 15-29 years, affected the sexes equally, and were not obviously influenced by menstrual cycle. Of the perceived precipitating factors, skin cooling occurred in 34 percent, emotional stress in 10 percent, physical exertion in 7 percent, and pregnancy in 5 percent of women of child-bearing age. Cold as a precipitant was not less common in patients with more subcutaneous fat. Pain affected the lumbar spine in 49 percent, abdomen in 32 percent, femoral shaft in 30 percent, and knees in 21 percent. There was a highly significant excess of bilateral involvement in limb and rib pain. Recurrent painful crises occurred in 40 patients but showed no evidence of involving similar sites on successive occasions. Abdominal painful crises were associated with abdominal distention in 18 ( 31 percent) and with referred rib pain in a further 15 (26 percent) of crises. Fever was common even in apparently uncomplicated painful crises, suggesting that fever is characteristic of the painful crisis itself after and not necessarily indicative of infection. Following investigation and treatment in a day-care centre, over 90 percent of patients returned home (AU)

Calcaneal spur in Guyana

The clinical features and management of 114 women with calcaneal spur seen at the Georgetown Hospital, Guyana are described. The condition occurs most commonly in fat, fertile, females over forty with flat feet. It is three times more common in East Indian women. The painful heel is due to a fibrotic response similar to plantar fibromatosis and not to the spur of bone which is the end result of recurrent strain on the plantar fascia combined with excision of the calcaneal spur (AU)

Some non-infective diseases endemic in the West Indies

The West Indies, and associated parts of the Caribbean area, are extremely diverse and afford interesting examples for the study of geographical medicine. Short accounts are given of some conditions whose aetiologies have been relatively recently clarified, including vomiting sickness of Jamaica, veno-occlusive disease of Jamaica, blackfat pulmonary fibrosis of Guyana, and epidemic acute glomerulonephritis of Trinidad. The aetiology of tropical sprue, which is common in Puerto Rico and absent from Jamaica remains to be explained although a hypothesis has been put forward. Further work is needed to establish the geographical distribution of idiopathic cardiomegaly and the spinal neuropathies and associated syndromes of retrebublar neuritis and sensorineural deafness before their aetiologies can be understood (AU)

Rontgenpatologi i Vastindien / Roentgen pathology in the West Indies

Roentgen pathology in Jamaica includes, inter alia, skeletal changes caused by avitaminoses, infectious diseases such as syphillis or tuberculosis, and sickle cell anemia. This form of anaemia may produce also renal papillary necrosis. Worm infection with stronglyoides stercoralis causes extensive inflammatory changes in the small bowel. Malformations of the urinary tract and bones are relatively common. (AU)

Haemoglobin SC disease in Jamaica

A skeletal survey was carried out on 84 cases of haemoglobin SC disease. The radiological features noted were increased translucency of bone, abnormal trabecular pattern, medullary expansion, wide vascular channels in phalanges, and radiological evidence of infarction, both medullary and cortical. The frequency of bone lesions thus demonstrated increased with age. The most characteristic lesions in this region were those of vascular necrosis; contributing factors such as the high haemoglobin level characteristic of the condition are discussed. An interesting feature was the lack of correlation betweeen clinical severity and degree of radiological change. (AU)

Conditions of the hip associated with hemoglobinopathies

In the Western hemisphere where malaria and parasitic infection is rare, the complications of the abnormal hemoglobins are those essentially of infarction. Hyperplastic changes never reach the extent seen in West Africa, infection is a less serious problem, patients survive into adult life and the hip joint produces a large proportion of the orthopedically crippled. Treatment follows the same lines which would be adopted in a patient with avascular necrosis of the femoral head with normal hemoglobin. The prognosis is worse because the age of onset is usually later resulting in slower and less complete restoration to normalcy. Special care in the general management of patients during operations is essential, particularly the avoidance of excessive blood loss or anoxia which may precipitate a crisis (summary)

Bone histological changes occurring after haemodialysis treatment for chronic renal failure

The changes that occurred in the histological appearances of iliac crest biopsies after haemodialysis for chronic renal failure in 16 patients are described. In the majority there is loss of bone and an increase in resorptive activity that resembles that seen in "disues" osteoporosis. The amount of osteoid present increases in most of the patients and other defects of calcification also make their appearance during the period of dialysis. None of the changes is peculiar to patients treated in this way. The findings are discussed in the light of hypotheses advanced on the condition of "dialysis bone disease".(AU)

Radiological changes associated with leg ulcers in the tropics

The radiological changes associated with four distinct types of leg ulceration common in the tropics are reviewed. Only mild changes occurred in the tropical phagedenic group, but more marked radiological abnormalities occurred in the three chronic groups. The frequency and pattern of the periosteal reaction is the most useful guide to radiological differentiation of these groups. (AU)

Clinical features of homozygous SS disease in Jamaican children

The clinical features in the first 12 years of life of 100 patients with homozygous SS anaemia are described. The majority of patients presented before age 2 years. The earliest diagnosis was made at 3 months of age. The hand foot syndrome, painful crisis and megaloblastic change were early manifestations of disease, whereas leg ulceration did not occur until beyond the age of 6 years. No examples of haemolytic crises were seen. Growth did not appear to be retarded by Jamaican standards. Death occurred in 2 cases (AU)

The relationship between Blount's disease and bow legs

The radiological appearances of the infantile form of Blount's disease (tibia vara) are described. These consist of a various deformity of the upper end of the tibia, torsion of the tibial shaft, irregularity and fragmentation of the medial part of the tibial metaphysis and gross thickening of the cortex on the medial side of the tibial shaft. This condition is very common in Jamaica and presents clinically as severe as bow legs. A study of the knees of 75 Jamaican children who presented with severe bow legs was carried out. Radiological examination revealed three different appearances. I. Severe simple (physiological) bow legs. 111. Early Blount's disease, due to a defect in the medial part of the metaphyseal beak, the metaphyseal "tear". III. Typical Blount's disease. Thirty cases showed transition from I to II or III and II to III. Evidence from the present study suggests that the development of the changes of Blount's disease in children with severe but simple bow legs is due to the increased proportion of the body weight which is supported by the medial part of the tibial metaphysis. This is described as eccentric pressure. The Jamaican child walks at an earlier age than the British child which results in the Jamaican child walking on the physiological bow legs. The British child walks on legs which are straight or show physiological knock knees. This is the racial factor. It is suggested that because of the normal plasticity of bone the child who walks on physiological bow legs will develop severe bow legs. This would explain the high incidence of severe bow legs in Jamaican children and hence the fact that Blount's disease may develop. Therefore, the three factors, eccentric pressure (due to severe bow legs), racial factors (early walking) and natural plasticity of bone are thought to be responsible for the persistence of physiological bow legs, the high incidence of severe bow legs and the development of Blount'd disease in the Jamaican child.(AU)

A survey of bone and joint disease in Jamaica - abstract

Little information exists of the incidence of bone and joint disease in the tropics. For this reason the conditions seen tend to be neglected as they behave differently from the same conditions in temperate climes where most of the doctors have been trained. Knowledge of their frequency is essential for teaching purposes and to plan clinical research. This survey has been made by keeping a list of the diagnosis of every new out-patient seen during 1954 and 1955, a total of 4,500 cases. The traumatic cases are not of particular interest and have not been analysed. Although the incidence of rare conditions is perhaps higher than in a general hospital, it is not unduly out of proportion as many such cases have been referred from medical and paediatrics clinics and have not been included. Tuberculosis is common and usually responds well to conservative treatment once the elements of malnutrition is corrected. Yaws seems to be dying out rapidly. Gonococcal arthritis is common. Rheumatoid arthritis, Stills disease and ankylosing spondylitis are fairly common, considerably more so than was at first thought. Osteoarthritis mainly affects synovial membrane and is relatively uncommon in the hip but quite common in the knee. Severe cases are unusual and usually are secondary to some obvious long-standing abnormality. Foot troubles are rare except for club feet which are of similar incidence to other countries. The knee ligaments are frequently strained but a meniscus tear is very unusual. Shoulder degenerative changes are very common. Spondylosis is relatively common and accounts for a proportion of paraplegics, most of which do not present at an Orthopaedic Clinic. Disc lesions in the lumbar region are common, only very few are severe enough to warrant surgery. Certain congenital lesions not seen elsewhere occur particularly around the knee. The ostoechondritis juveniles group is common. Bone lesions of sickle cell disease are common and frequently go undiagnosed. Neoplasms are of a similar incidence to that seen in temperate regions. (AU)