Effect of thermal stimuli on peripheral blood flow in homozygous sickle cell disease: a preliminary study

Forearm blood flow (FBF) was measured in 23 patients with homozygous sickle cell (SS) disease and 20 controls with normal hemoglobin genotype (AA) using venous occlusion air plethysmography to examine the pattern of peripheral blood flow in both groups at rest, and in response to thermal stimuli. The mean resting in FBF in SSS patients was more than twice that in AA controls (P < 0.05) in FBF in the opposite arm in both SS patients and AA controls, with the response being greater in the controls. Indirect heating for 2 mimutes evoked a similar decrease in FBF of a similar magnitude in both groups. The increased FBF in response to cooling in SSS patients may be a part of an important reflex mechanism which would support the concept of the 'steal' syndrome, as recently postulated, as a possible explanation of the cold-related initiation of the painful crisis of SS disease.(AU)

The painful crisis of homozygous sickle cell disease: a study of the risk factors

Some epidemiologic features of the painful crisis in homozygous sickle cell disease were examined in a retrospective study of 995 painful crises. Previously reported associations with cold weather and pregnancy were confirmed. There was a striking increase in painful crises in male patients between the ages of 15 and 25 years, whereas female patients showed little age-related change. The frequency of painful crises correlated positively with hemoglobin levels and reticulocyte counts in female patients. There was a striking increase in painful crises in male patients with hemoglobin levels above 8.5 g/dL (>85 g/L). High hemoglobin levels appear to be an important risk factor for painful crises.(AU)

Bronchomotor tone in protein-energy malnutrition

The study examined the reactivity of the tracheobronchial tree of rats maintained on low protein and tryptophan-deficient diets. It was found that: (1) Rats maintained on 5 percent protein or triptophan-deficient diets showed little or no weight gain. A 15 percent protein diet was adequate for normal growth of female rats, but not of male rats. (2) Airways of malnourished rats showed significant bronchoconstriction when treated to an acetylcholine (AcCH) concentration of 10 to the 11 power M. The treshold concentration of AcCh for normal rats was 10 to the -5 M. Airways of malnourished rats were also more sensitive to cold. (3) Rehabilitation of the malnourished rats attenuated the response to AcCh. Recovery, however, was not complete. (4) Prior application of phentolamine and atropine markedly reduced the sensitivity of the airways of malnourished rats to AcCh. The results seem to indicate that O-adrenoceptors and the vagus nerve may be involved in the observed increased reactivity of airways of malnourished rats.(AU)

Nursery admission temperature in immature newborns: the effects of birth-arrival interval and asphyxia

The results of a study on 175 immature neonates of less than 37-weeks gestation born at the University Hospital of the West Indies between August, 1973 and March, 1975 and transferred directly from the delivery area to the nursery have been presented. The mean birth weight was 1,766 grams and the mean gestation age 33.4 weeks. The mean admission temperature was 35.2§C (95.4§F) which was significantly related to a long birth-arrival interval, the mean for which was 30.2 minutes. Severe neonatal asphyxia resulted in lower mean admission temperatures in spite of more rapid transfer (AU)

The response of malnourished babies to cold

Twelve malnourished Jamaican children, aged 4-6 months, were studied before and after treatment, to see whether malnutrition impared their response to cold. When they were studied in the post-absorptive state and in a neutral thermal environment, they had a lower rate of oxygen consumption per kg body weight, a slower pulse rate, lower body temperatures, lower R.Q., and evidence of a smaller peripheral blood flow on admission to hospital than they did after recovery. The malnourished children failed to increase their heat production above resting levels at 25§ C, and their rectal temperature fell at a rate of 1§ C/hr in spite of a further decrease in peripheral circulation. When they had recovered they maintained their body temperature within the normal range on exposure to this temperature, while increasing their heat production by 20 percent. The thermogenesis was apparently of the non-shivering type. There was evidence of increased metabolic activity in the interscapular brown fat pad at 25§ C both on admission and before discharge. In the malnourished children this activity was not sufficient to produce a measurable increase in total oxygen consumption. Interscapular brown fat was examined at autopsy in thirteen malnourished and fifteen well nourished children aged 1-24 months. Lipid depletion was found in this tissue in the former but not in the latter. This may explain the impared response of the malnourished child to cold. (AU)

Malignant hypertonic hyperpyrexia

A case of malignant hypertonic hyperpyrexia is reported, occurring in a 2 1/2 year old Chinese boy living in Jamaica. The illness progressed rapidly with a fatal outcome, in spite of active resuscitation. Aetiology, diagnosis and treatment of the condition are briefly discussed (AU)

Facial palsy: a multifactorial entity

Facial Palsy is not a common condition in Kingston, Jamaica, only 21 cases being treated at the Kingston Hospital between 1958 and 1968. Statistical problems arise as a result of sampling distortion consequent on omission from the diagnotic records because of other overwhelming conditions, no attention being sought for the condition, or the patient being lost to follow-up. The age range is wide. Men were more commonly affected than women and at an older average age. A seasonal incidence has been demonstrated, some 71 percent (15/21) of the cases occurring in the warm season of the year (April to October). Older patients are more commonly affected during the warm months, raising the possibility of a vacular ischaemic process. Other aetiological factors such as exposure to cold, infections of viral or non-viral type, diabetes, and trauma are discussed. Trauma accounting for some 20 percent (4/21) of the cases seemed a particularly high percentage in this Jamaican series. The recovery rate in those followed up was favourable. Onset in summer and early spring appeared to exert a favourable prognostic effect (Summary)

Paroxysmal cold haemoglobinuria in Jamaica. A case report

Paraxysmal cold haemoglobinura is very rarely encountered in warm climates. A patient with haematological and serological evidence of the disease is described and current concepts on the haemolytic mechanism discussed. This brings to four the total cases recorded, occuring in warm climates (AU)