Acute carpal tunnel syndrome secondary to thrombosis of a persistent median artery

An ususual case of thrombosis of a persistent median artery as a cause of acute carpal tunnel syndrome is reported. The sudden onset of numbness in the median nerve distribution and pain in the fingers were main symptoms. The embryonic development of the median nerve vascular supply and the reported incidence of persistent median artery are reported(AU)

Mesenteric venous thrombosis and oral contraceptive use

A case of mesenteric venous thrombosis in a young woman receiving oral contraceptives is reported. This is the first case encountered in the Caribbean region. (Au)

Sensori-neural hearing loss in Jamaicans with SS disease

The pure-tone hearing levels in 83 Jamaican patients aged from 10-39 with homozygous sickle cell disease were compared with appropriate controls. A sensori-neural hearing loss, defined as a deficit of at least 25 dB in one or more frequencies, was found in 18/83 (22 percent) patients and in 3/83 (4 percent) controls. Both sexes and ears were equally affected, but the extremes of the tested range, especially the high tones, were involved most frequently. The hearing loss was of slow onset. The relative contributions of thrombosis, anaemia, atherosclerosis and Jamaican neuropathy are discussed. It is felt that the most likely aetiology is a thrombotic process. (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)

Immediate operation for prolapsed thrombosed haemorrhoids

Results of operations for prolapsed thrombosed haemorrhoids are compared with the results of routine haemorrhoidectomy. The long tradition that this operation is dangerous, does not seem to be supported by this small series of cases(AU)

Jamaican cardiomyopathy

Eight cases of cardiomyopathy found in Jamaica are described. The ages ranged from 19 to 60 years. There were six men and two women. All the hearts were enlarged, the weights ranging from 480-370 g, except for one patient in whom the heart weighed 275 g. The principal pathological finding was fibrous thickning of the endocardium confined to the left side in seven patients and most evident in the ventricles. Four hearts showed mural thrombi which in two instances had given rise to systemic emboli. Valvular involvement -slight-was seen in only three patients. The endocardial thickenings contained deposits of fibrin and originated from them. This cardiomyopathy resembles most closely "heart muscle" disease found in Nigeria (Summary)

The mid-forearm arteriovenous fistula as vascular access for haemodialysis

Successful chronic haemodialysis requires permanent vascular access. The Scribner procedure which utilizes an external arteriovenous shunt, the internal synthetic arteriovenous shunt and the direct arteriovenous fistula as described by Cimino and Brescia have all been used for haemodialysis. Of the three methods, the arteriovenous fistula is the most trouble-free and durable. However, as originally described and constructed in the distal forearm, the morbidity associated with this method is significant. The cubital fossa fistula has even more problems. The mid-forearm fistula was designed by the authors and has been used for chronic haemodialysis over the past eighteen years. This article compares the various methods of access used in the haemodialysis units of the University Hospital of the West Indies and the Kingston Regional Hospital. The mid-forearm fistula was found to have lowest initial failure rate and was associated with fewer complications than any of the other methods used for access. (AU)