Red lesions of the oral mucosa

Oral soft tissue lesions, which clinically appear red, are common. These lesions may present themselves in different clinical forms. They may be patchy, spotted, macular, papular, nodular, localized, diffuse, single, multiple and so on. Lesions that appear red may be considered primary when they appear when they appear as a result of local causes. They are secondary when their occurence is a result of systemic pathology. It is not uncommon that red lesions may be associated with pigmented or white lesions. In this chapter, commonly encountered red lesions of the oral mucosa are briefly discussed (AU)

Bleeding disorders

The primary objective of this chapter is to deal with the most important bleeding disorders from a dental point of view. An understanding of the disorders discussed in this section hinges upon a basic knowledge of the various physiological processes involved in normal haemostasis (AU)

Medical admissions of oncology patients to the University Hospital of the West Indies

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7 percent of total admission to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62 percent were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7 percent of admissions, the commonest being renal and/or hepatic impairment: anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35 percent of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).(AU)

Autoimmune haemolytic anaemia, immune thrombocytopenia, and leucopenia - an unusual presentation of hodgkin's disease

We report an unusual case of modular sclerosing Hodgkin's disease in a 17 year old women presenting with intermittent fever, progressive weight loss and enlarged cervical and anxillary lymp nodes. Laboratory test revealed severe Coombs' positive haemolytic anaemia, and progressive thrombocytopenia and leucopenia, associated with erythroid, myeloid and megakaryocytic hyperplasia, but with no evidence of lymphomatous infiltration in the bone marrow. Transfusion of compatible blood became possible only after prednisone therapy and a single intravenous dose of vincristine. Appropriate chemotherapy led to normalization of the peripheral blood counts and a negative direct Coombs' test.(AU)

Primary antiphospholipid syndrome: a case report

A case of the primary antiphospholipid syndrome (PAPS) in a 21-year-old Jamaican female is described. Recurrent abortions, thrombocytopenia and neurological complications as well as lupus anticoagulant positivity in the absence of features of systemic lupus erythematosus (SLE) were the main clinical findings. Diagnostic criteria, treatment and prognosis are discussed. When the antiphospholipid syndrome (APS) is present in the primary form, the diagnosis may be difficult but its recognition may prevent those vascular events which can lead to significant morbidity and foetal wastage (AU)

Thrombocytopenia in severe pre-eclampsia and eclampsia - abstract

A retrospective study was conducted on 15 cases of eclampsia and 9 cases of severe pre-eclampsia to record the incidence of thrombocytopenia in these cases and to evaluate its clinical significance. Thrombocytopenia occurred in 8 of the 15 eclamptics and 5 of 9 severe pre-eclamptics. Tests for other coagulation defects revealed the frequent association of thrombocytopenia, hypofrinogenaemia and prolonged prothrombin time. The clinical significance is discussed (AU)

Leptospirosis in Barbados - abstract

Leptospirosis was first documented in Barbados by Bayley in 1939. Since that time it has continued to be a major cause of jaundice on the island, accounting for approximately fifty percent of the cases admitted to the medical wards. In 1979, the Government of Barbados in collaboration with the Medical Research Council (MRC) of the UK set up a laboratory for the diagnosis and study of the disease. In serological surveys carried out on the Island, Everald showed that 18.5 percent of 529 individuals tested from urban and rural areas had significant titres indicating previous exposure. Likewise, in a survey of school childern, he showed that 7.6 percent of 538 samples tested had significant titres. The majority of cases were exposed to the serovar Autumnalis. Autumnalis bim was first isolated by Jones from a stray dog in Bridgetown. It has subsequently been shown that bim is the most frequent cause of severe disease in man in Barbados. Two hundred and seventy-six hospital cases of leptospirosis have been confirmed since the inception of the laboratory in late 1979 to the end of December 1987. The cases seen in hospital have varied from 25 to 57 in any one year. On average, 15 cases per 100,000 population are admitted each year. The overall mortality rate has been 14.1 percent; however, since the inception of clinical research studies and aggressive supportive care in 1983 the mortality rate has been reduced to 9.4 percent. In 1981, a retrospective study of the incidence of thrombocytopenia in leptospirosis confirmed our published retrospective study showing that 30 of 49 (61.2 percent) patients had a platelet count of 100,000 or less. The association of thrombocytopenia and renal failure was also confirmed. In a study of twenty-four patients at the end of the first year of our MRC/UK-sponsored research programme, thrombocytopenia was demonstrated in 14 of these pateints. The only additional laboratory evidence suggestive of a disseminated intravascular coagulation lay in a mild elevation of the fibrinogen degradaton products, but this occurred with equal frequency in the non-thrombocytopenic patients. There was thus no casual relationship between the DIC and thrombocytopenia of leptospirosis. A randomized control study of high dose intravenous pencillin in icteric leptospirosis was conducted over a three-year period ending in December 1986. Thirty-eight patients were randomised to antibiotic therapy and forty-one to recieve intravenous fluids only. The two groups showed no significant difference in the time to defervence, return of biochemical parameters to normal, incidence of iritis or mortality in the two groups. Three patients (7.3 percent) died in the control group and one (2.6 percent) in the treatment group. The overall mortality for the study was 5.9 percent. Leptospires were recovered from urine cultures in six patients from the control gorup and none in the antibiotic group. It was concluded that while intravenous penicillin may sterilise the urine, it had little effect on the overall clinical outcome of jaundiced patients with leptospirosis. Twenty-four percent of patients had a cardiac arrhythmia, pericarditis or mycarditis when monitored by electrocardiagrams, halter monitor and echocardiagrams. Studies on the high incidence of hyperamylasemia (65 percent) in our leptospirosis patients are now in progress. The laboratory is continuing studies on the early diagnosis of the disease, looking at the application of common and specific DNA sequences from serovars of Leptospira interrogans for the diagnosis and distribution of leptospirosis, with the help of a new grant from the EEC (AU)

Thrombocytopenia in leptospirosis: the absence of evidence for disseminated intravascular coagulation

In a prospective study of human leptospirosis, thrombocytopenia was demonstrated in 54 percent of 24 cases. The only additional laboratory evidence suggestive of disseminated intravascular coagulation lay in a mild elevation of fibrinogen degradation products, but this occurred with equal frequency in nonthrombocytopenic patients. There is therefore no causal relationship between disseminated intravascular coagulation and the thrombocytopenia of human leptospirosis. (AU)

Thrombocytopenia in leptospirosis: the absence of disseminated intravascular coagualation - abstract

This study was undertaken to test the hypothesis that thrombocytopenia in patients with severe leptospirosis is due to Disseminated Intravascular Coagulation (DIC). Twenty-four patients with leptospirosis were admitted to Queen Elizabeth Hospital between October 1, 1983 and September 30, 1984. All patients had serial measurements of haemoglobin, platelet count, blood smear, PT, PTT, fibrin degradation products (FDP's), thrombin time, fibrinogen titre, C3, C4, bleeding time, haptoglobin and bilirubin. Thirteen (54 percent) patients had thrombocytopenia (platelet count <100,000/cæ mm) and 23 (96 percent) were jaundiced with a mean serum bilirubin concentration of 196 æ mol/l (range 17-624 æ mol/l (normal <17 æ mol/l). There were mild elevations of C3, C4 and serum haptoglobin. Three thrombocytopenic and one patient with normal platelet count had a one-second elevation of PT. All four patients demonstrated normal PT's on subsequent days although the platelet count in the 3 thrombocytopenic patients was still decreased. FDP's were elevated in 63 percent of non-thrombocytopenic and 64 percent of thrombocytopenic patients. The elevation was mild: it was above 10 æg/ml (normal <7.5) in one patient. Non-leptospiral jaundiced patients also had elevation of FDP's. All other variables tested were normal. It is concluded that there is no evidence for disseminated intravascular coagulation in leptospirosis since the expected concomitant changes indicative of a DIC did not accompany thrombocytopenia. It is suggested that the marginal elevation of FDP's seen in our patients is due to hepatic dysfunction (AU)

Thrombocytopenia in leptospirosis

In a retrospective study undertaken to document the frequency of thrombocytopenia in cases of leptospirosis, 18 of 32 patients (56.3 percent) had a platelet count of 100 x 10 3/mm3 or less. Renal failure occurred in 72.2 percent of thrombocytopenic patients and in 21.4 percent of patients with normal platelet counts. The association of thrombocytopenia and renal failure was significant (P<0.02). The common occurrence of thrombocytopenia and its association with acute renal failure in patients with leptospirosis has not previously been reported. (AU)

An unusual case of raised intra-cranial pressure in a child

A young girl who presented with raised intracranial pressure was thought to have a tumour in the parieto-temporal region, where a "tumour circulation" was seen on carotid angiography. However this lesion proved not to be a tumour but intra-cerebral and subdural haematomata, secondary to thrombocytopaenic purpura for which she has since be treated by splenectomy. (AU)

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)

A study of the blood in leprosy: cytology and clotting

Ninety cases of leprosy were examined. All cases except two were under treatment with the sulphones. A hypochromic, normocytic anaemia was present in 80 percent of males and 60 percent of females. This had been reported previously in leprosy and also in patients under treatment with the sulphones. Nine per cent of cases showed a marked basophilia and basophils were present in 26 percent of cases. The relationship is not understood. Twenty-five per cent of cases showed the presence of atypical monocytes, a finding which has previously been observed in leprosy. A contradictory tendency to thrombocytopenia with a shortened bleeding time was found, with normal clotting and prothrombin times. The significance of these findings is not understood. (AU)

A multiplicity of reactions to carbutamide (BZ-55) therapy

The case of a diabetic adult male who exhibited a number of serious toxic reactions to carbutamide administration is reported. The findings included thrombocytopenia, fever, lymphocytosis, generalized lymphadenopathy, exfoliative dermatitis, hepatitis and the development of a secondary anemia. Recovery followed administration of cortisone. Delayed "hypoglycemic" episodes were associated with adminstration of high dosage of the drug.(AU)