Thyrotoxic vomiting: a case report

A post menopausal female with severe vomiting and weight loss in association with elevated hormone levels is presented. Signs and symptoms of thyrotoxicosis were not evident at presentation. Possible pathophysiological mechanisms and treatment are discussed. Antithyroid therapy with carbimazole and propranlol induced rapid resolution of her symptoms and marked improvement in well-being. Radioactive iodine ablation of her thyroid gland was performed later and she has remained asymptomatic.(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)

Fat embolism syndrome following long bone fractures

During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided. (AU)

Fat embolism syndrome following long bone fractures

During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided.

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.

Helicobacter pylori in patients undergoing upper endoscopy in Jamaica

One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were tested for H. pylori by a rapid urease test, using antral biopsy specimens. There were 60 men (mean age 54 yrs) and 42 women (mean age 49 yrs). Fifty-six patients (55 percent) were positive for H. pylori. Of male patients, 36 (60 percent) and of female patients, 20 (48 percent) tested positive. Sixty-eight per cent of patients with antral gastritis, 65 percent with duodenal ulcer and 60 percent with gastric ulcer had H. pylori. Thirty-nine patients (70 percent) positive for H. pylori were from major urban areas, and 17 (30 percent) were from rural areas of Jamaica. In patients without H. pylori, 61 percent and 39 percent were from urban and rural areas respectively. Forty-four patients (79 percent) with H. pylori and 40 (87 percent) without H. pylori had piped water in their homes. Ninety-three per cent of all patients had electricity and 88 percent had refrigeration. There was no difference between patients positive or negative for H. pylori with regard to the use of alcohol, marijuana or tobacco. There was also no difference between both groups in exposure to domestic animals in the home environment. H. pylori is associated with antral gastritis and peptic ulcer disease in Jamaican patients. There are no specific environmental or social factors that seem to predispose to infection (AU)

Thyrotoxic periodic paralysis in a Jamaican male patient

A case of thyrotoxic periodic paralysis occurring in a Black Jamaican male patient is described. Diagnosis is based on history and confirmed by evaluation of serum electrolyte during attacks and thyroid function studies. The physiopathology, associations, therapy and prognosis are discussed. It is important that clinicians recognise the condition as all forms of periodic paralysis are amenable to treatment, and progressive weakness can be prevented or even reversed. (AU)

Helicobacter pylori in patients undergoing upper endoscopy in Jamaica

One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were tested for H. pylori by a rapid urease test, using antral biopsy specimens. There were 60 men (mean age 54 yrs) and 42 women (mean age 49 yrs). Fifty-six patients (55//) were positive for H. pylori. Of male patients, 36 (60//) and of female patients, 20 (48//) tested positive. Sixty-eight per cent of patients with antral gastritis, 65//with duodenal ulcer and 60//with gastric ulcer had H. pylori. Thirty-nine patients (70//) positive for H. pylori were from major urban areas, and 17 (30//) were from rural areas of Jamaica. In patients without H. pylori, 61//and 39//were from urban and rural areas respectively. Forty-four patients (79//) with H. pylori and 40 (87//) without H. pylori had piped water in their homes. Ninety-three per cent of all patients had electricity and 88//had refrigeration. There was no difference between patients positive or negative for H. pylori with regard to the use of alcohol, marijuana or tobacco. There was also no difference between both groups in exposure to domestic animals in the home environment. H. pylori is associated with antral gastritis and peptic ulcer disease in Jamaican patients. There are no specific environmental or social factors that seem to predispose to infection.