Hepatic cirrhosis in Jamaica

The aetiology, biochemistry, clinical features and complications of histologically confirmed hepatic cirrhosis in 45 patients (26 females, 19 males) seen at the University Hospital of the West Indies, Jamaica, between 1984 and 1994 was presented. The age range was 1 to 72 years (mean 48 years). Abdominal swelling and weight loss were the commonest symptoms, occurring in 51 percent and 47 percent of patients, respectively. Jaundice was a presenting feature in 44 percent. Hepatomegaly was present in 71 percent of patients and splenomegaly in 33 percent. The aetiological factors were: alchol (36 percent), bush tea (18 percent), chronic active hepatitis (11 percent), drugs (7 percent), and haemochromatosis (2 percent). Hepatitis B surface antigen was detected in 2 of 20 patients tested. 24 percent of the patients also had diabetes mellitus, 29 percent were anaemic, 29 percent were thrombocytopenic, 4 percent were leukopenic, and the prothrombin time was prolonged in 22 percent. The albumin/globulin ratio was reversed in 71 percent of the patients. The alkaline phosphatase was elevated in 56 percent, the aspartate aminotransferase was increased in 58 percent and the gamma glutamyl transpeptidase in 56 percent. 56 percent of the patients had macronodular cirrhosis; the liver showed a micronodular pattern in 18 percent; 7 percent had biliary cirrhosis; 7 percent chronic active hepatitis with cirrhosis; and 13 percent showed a mixed macro-micronodular pattern. Ascites and fluid overloaded developed in 44 percent of the patients. Hepatic encephalopathy occurred in 18 percent and upper gastrointestinal bleeding in 18 percent.(AU)

Pregnancy in chronic active hepatitis with cirrhosis

Pregnancy in chronic active hepatitis and cirrhosis is rare. There is an appreciable perinatal mortality and the effect of pregnancy on the underlying liver disease remains uncertain. Two patients with autoimmune chronic active hepatitis with cirrhosis who became pregnant during an active stage of their disease while on therapy are described. Both had an uneventful pregnancy with successful deliveries. One of the patients had two other prenancies but the pregnancy had to be terminated because of clinical deterioration. With close supervision patients with chronic active hepatitis and cirrhosis may have successful pregnancies. (AU)

Clinical features in histologically proven primary hepatoma

Clinical, biochemical and pathological features are assessed in 19 cases of histologically-proven primary hepatoma. 47 percent of the patients recalled the use of "bush teas" in childhood, though only one patient gave a history suggestive of acute veno-occlusive disease. An unusually high prevalence of micronodular cirrhosis was reported among the 18 patients coming to autopsy. Previously proposed carcinogenic mechaninsms are reviewed, and a possible role for senecio alkaloids in the genesis of primary hepatoma is considered (AU)

Acute veno-occlusive disease of the liver: fine structure in Jamaican children

Electron microscopic observations in humans veno-occlusive disease (VOD) of the liver are presented for the first time . Marked endothelial damage was seen in the sinusoids and subterminal and terminal hepatic veins, accompanied by extravasation of erthrocytes into Disse's space and naked hepatocytes showing a reduction in microvilli. Endothelial damage was seen in all zones of the liver. At the level of terminal hepatic veins, the closed structure of these vessels, absence of fenestrations, existence of a basement membrane, and the presence of collagen and connective tissue cells in the wall provide resistance to erthrocytes and cellular debris tracking up Disse's space. These factors tend to result in narrowing of the lumen where the sinusoid enters the vein. Parenchymal cell alterations, at the time of the biopsies, included dilation of bile canaliculi, abundant glycogen, and nuclear invaginations.(AU)

The pathology of sickle cell anaemia in Jamaican adults over 30

The pathological findings at autopsy in 7 patients over the age of 30 with sickle cell anaemia are described and discussed. The 3 youngest died of well recognized complications of sickle cell anaemia. The 4 older patients, all over 50, had been remarkably free of direct complications and died of disease which could have been unrelated to sickle cell anaemia. Cirrhosis and chronic nephritis were not seen. Pulmonary vascular disease was seen in 2 patients but its significance in relation to sickle cell anaemia has not yet been established in Jamaican patients.(AU)

Hereditary hepatolenticular degeneration (Wilson's disease): report of the first case in Jamaica

Hereditry hepatolenticular degeneration (Wilson's disease) is described in a 13-year old Negress. This case, the first reported in Jamaica, has provided substantial evidence of genetic mutation in the Negro race through a careful study of the family history. The clinical picture was characterized by extrapyramidal and unilateral pyramidal motor signs. The diagnoses was based on the presence of Kayser-Fleischer rings, an abnormally high urinary copper content, and a very low serum caeruloplasmin concentration. Advanced post-necrotic cirrhosis was disclosed at autopsy despite no evidence of liver disease during life. Unusual features present were a raised serum uric acid concentration, a high copper content in the spinal cord and arterial calcification in the globus pallidus. (AU)

Atherosclerosis in persons with selected diseases

Comparison has been made of measures of coronary and aortic atherosclerosis in autopsied persons having five selected diseases (lung cancer,stomach cancer, other cancer, cirrhosis of the liver, and tuberculosis) with similar measures in control cases. There appears to be a slight but not significant tendency for lung cancer to be associated with more severe atherosclerosis within age-location-race subgroups. The tendency is strongest in the abdominal aorta. None of the other four diseases appears to be associated with increased or decreased severity of atherosclerosis in comparison with the control groups.(AU)

Congenital hepatic fibrosis in Jamaican children

Clinical and pathological data are presented on 8 children with the syndrome described as congential hepatic fibrosis. The karyotypes were normal in 3 children in whom this examination was undertaken. Four also had polycystic disease of the kidneys. These studies emphasize the presence of recurrent fevers and infections and severe anaemia as being important features when the disease occurs in early childhood. Clinical portal hypertension was not seen. As in previous studies, a strong familial tendency was encountered. The exact aetiology remains obscure. (Summary)

BSP excretion in Megakaryocytic Thrombocytopenia

Cirrhosis of the liver is occasionally associated with megakaryocyte thrombocytopenis. Bromsulphthalein excretion tests were performed in 11 patients with the latter disease and of these 6 patients showed evidence of liver disease on the basis of these tests. In an area where liver cirrhosis is a common entity this relationship may be diagnostic importance (AU)

Observations on liver cirrhosis in cattle (abstract only)

Cirrhosis of the liver in cattle has become a problem in the intermediate savannahs of British Guiana. This area is one of open undulating grassland which is known to be minerally deficient. Cattle of all ages and sex are affected and the diagnosis is often made at the time of slaughter for market. A toxic plant, protein deficiency, mineral imbalance or toxicity are all suspected as being responsible for this condition. A botanical survey has been carried out and three species of Crotalaria have been identified in this area. It is suggested that at the end of a long dry season the animals are less selective in their grazing habits and are forced through lack of better grasses or from the fibrous nature of the grasses at that time to consume material that is toxic or of sufficiently low protein value to reflect in adverse changes in liver tissues. Liver biopsies show a regression of fibrosis even in extreme cases and arrest of the process in animals at certain times during the year or when the animals are taken from the range and put on improved pastures (AU)

Veno-occlusive disease of the liver: surgical aspects

Veno-occlusive disease of the liver is a recently established disease entity. Its etiology, pathology, and symptomatology, and natural history are discussed on the basis of 99 cases of this disease so far authenticated at the University College of the West Indies. In the surgical literature the disease is added to the list of causes of intra-hepatic portal hypertension, and the cases of 4 patients are presented in detail in whom portacaval anastomoses were performed for the decompression of esophageal varices. The surgical implications of this disease have been stated and some of the difficulties enountered in the treatment of portal hypertension in infants and children outlined (Summary)

Cirrhosis of the liver in Jamaica

The incidence of cirrhosis of the liver in a necropsy series in Jamaica is analysed. There were 77 cases (4.9 percent of necropsies), which could be classified morphologically as follows: post-necrotic, 30 percent; portal, 28.5 percent; post-veno-occlusive disease (VOD), 30 percent; biliary, 1.3 percent. The morphogenesis of cirrhosis following VOD is discussed.(AU)

Cirrhosis and liver cancer in Jamaica (abstract only)

The overall incidence of liver cirrhosis in 1560 autopsies (still-births excluded) at University College Hospital is 4.9 percent. Morphological study reveals approximately one-third each of portal, post-necrotic and post-V.O.D. types. Various aetiological factors are presented and the morphogenesis, particularly of post-V.O.D. cirrhosis, is discussed. Primary carcinoma of the liver in Jamaica occurs more frequently than is reported in Europeans, but much less than in Africans. Hepatocellular carcinoma is more common than cholangiocarcinoma and there is predilection for the young adult male (AU)