Pregnancy complicated by thyrotoxicosis

Of 17 pregnancies complicated by thyrotoxicosis, detection and treatment commenced in 11 before conception, and in 6 during pregnancy. Treatment consisted of carbimazole alone in 13, and carbimazole and propanolol in 4 pregnancies. There was one abortion in the group treated with carbimazole. In the four pregnancies managed with carbimazole and propanolol, there were two perinatal deaths. There was adequate response with minimal doses of anti-thyroid drugs, supported by clinical assessment and assays of thyroid hormones (AU)

Hyperthyroidism complicating pregnancy:results of treatment by antithyroid drugs in 34 pregnancies - abstract

Thirty-four pregnancies (36 infants) complicated by hyperthyroidism were seen at the General Hospital, Port-of-Spain, and the Mount Hope Women's Hospital during a 6«-year period. This retrospective study was done to determine the foetal and maternal morbidity and mortality associated with hyperthyroidism in pregnancy. The best form of therapy, whether anti-thyroid drugs alone or in combination, is evaluated, comparing our findings with other series from the 1950s to the 1980s. Hyperthyroidism was diagnosed following conception in 6 pregnancies, and detection and treatment commenced in 28 before conception. Treatment was with carbimazole alone in 26 with modified dosages of 5 to 15 mg daily. Carbimazole and propranolol were used in seven, and propylthiouracil in one pregnancy. The total foetal loss was 18 per cent with a perinatal loss of 9 per cent. There were no premature deliveries but one abortion in the group treated with carbimazole alone. In pregnancies treated with carbimazole and propranolol, there were four premature deliveries ending with perinatal death (including one death due to congenital abnormalities) and a second trimester abortion of one set of twins. No infant had goitre. Twenty-five (86 per cent) of the surviving infants were above the 25th centile for gestational age. There was a relative excess of infants with premature labour and birth weight less than the 25th centile in the pregnancies with treatment beginning following conception. The complication of hyperthyroidism in pregnancy can be treated effectively with minimal doses of anti-thyroid drugs alone (AU)

Plasma insulin responses to oral glucose in normal and diabetic Jamaicans

The plasma insulin reponses to oral glucose have been determined in 96 normal and diabetic Jamaican subjects during standard oral glucose tolerance tests. The results are discussed with respect to: (a) possible aetiological factors causing diabetes in Jamaica and (b) the existence or not of racially determined differences in metabolic responses (AU)

HLA antigens in diabetics of African descent in Trinidad - abstract

The pattern of HLA distribution was studied in one hundred and fifteen Trinidadian diabetics of African ancestry. Insulin-dependent diabetes (IDDM) patients showed a positive association with HLA - A11 and B5 antigens (p<0.05) with relative risks of 5.9 and 3.2 respectively. In addition, HLA -B8 showed a positive but not statistically significant deviation, while HLA - B12 showed a negative association (relative risk 0.27). There was no association found between HLA -B15 and IDDM. Maturity-onset diabetics (MODM) showed positive association with HLA - B5 (p <0.025 and relative risk 2.93), and a significant negative association with HLA - A2, A3 and A9. In most populations, strong associations may be found between certain HLA antigens and IDDM, the associations" varying depending on the ethnicity of the population. Interestingly, no association has been observed between HLA antigens and MODM in Caucasian populations. However, several workers have observed significant deviations of HLA antigens in indigenous African MODM patients. In addition, the inconsistency of HLA antigen associations with IDDM in persons of African ancestry compared to that in Caucasians has led to the suggestion that diabetes mellitus in native Africans is genetically different from that in Caucasians. Our findings would tend to support this view (AU)

Circulating lymphocyte response during acute infection - abstract

The circulating lymphocytes in peripheral blood comprise a group of cells with different origins, life span, fine structure, and proliferative capacity. Under normal circumstances, these lymphocytes do not divide and peripheral blood from healthy individuals contains only about 0.1 percent of lymphocytes in DNA synthesis. This proportion is much increased in infectious mononucleosis, several viral, bacterial and rickettsial diseases and is even greater in acute and chronic myeloid leukaemia and other reticuloses. This study was undertaken to assess the DNA-synthesising ability of lymphocytes in peripheral blood of patients with infectious diseases and to ascertain if the proliferative response was related to the nature of the infecting agent. The agents studied included leptospira, proteus, pneumococcus, staphylococcus, streptococcus, tetanus, klebsiella and some viruses. DNA synthesis was assessed by the ability of the cells to incorporate tritiated thymidine (H3T) or I125 deoxyuridine (I125DU) into DNA, following a one-hour pulse in vitro I125 DU uptake was measured by scintillation counting which provided an index of the per cent isotope incorporation in a given population of cells. By H3T autoradiography, specific cell types undergoing DNA synthesis were identified and quantitated by the Labelling Index (number of cells labelled/total cells counted). A total of 84 patients and 16 normal control subjects were studied. The results by both method indicated a definite increase in percentage of DNA-Synthesising cells in all infected patients, the greatest response being in leptospira, proteus and pneumococcus infections. Response was low in klebsiella infections and in sickle cell anaemia patients with infected leg ulcers. The labelling indices showed a mean of 3.01 + 019 percent and 0.04ñ0.09 percent in leptospirosis and sickle cell anaemia respectively, as compared with a 0.3 percentñ0.00 percent in normals. These studies demonstrated that lymphoid elements stimulated in vivo initiate a phase of proliferation in what is apparently an immunologic reaction mounted against the foreign infectious agents. This proliferative response may provide a means of increasing the numbers of antigenically-activated cells or may function in a reparative way. The measurement of DNA-synthesising cells represents a sensitive tool in the investigation of inflammatory and immunoproliferative disorders (AU)

Hypothyroidism in diabetes treated with the sulphonylurea chlorpropamide - abstract

The study was undertaken to determine the effects of the sulphonylurea, chlorpropamide (Diabin) on thyroid function in diabetics. One hundred and twenty-five diabetic attending the Diabetic Clinic at the University of the West Indies were studied. They were divided into three groups, a control group of 46 patients on diet alone (11) or insulin (35), a second group of 46 patients on 250 mg chlorpropamide daily and a third group of 33 patients receiving 375 mg or more chlorpropamide daily. The three groups were matched for age, sex and duration of diabetes. No patient had been on other drugs known to affect thyroid function and they all had blood urea values within normal limits. A serum thyroxine estimation was done on each subject and all those values of less than 4.5 ug/100 ml were subjected to R.A.I. uptake studies before and after a single dose of T.S.H. In the control group 1 patient was found to have Hashimoto's disease. In each of the other two groups on chlorpropamide there were 3 hypothyroid patients. They all had low serum T4, low R.A.I. uptakes and good response to T.S.H. In three of these six patients the sulphonyl-urea was discontinued and the thyroxine levels rose to normal after varying intervals. It is concluded from this series that hypothyroidism occurs in 7.5 percent of patients on chlorpropamide and that this reversible on discontinuation of the drug (AU)

Erysipelothrix insidiosa endocarditis: a report of two cases in Jamaica

Two cases of erysipelothrix insidiosa endocarditis occurring in adult women, both of whom died, have been presented. This is the first report in Jamaica of infection with this organism. The clinical features of the illness are similar to those described elsewhere. The importance of accurately and fully identifying "diphtheriods" isolated from blood cultures is emphasized.(AU)

Thyroxine turnover studies in Jamaicans

Radioactively labelled thyroxine (T4 - 125 I) has been used to carry out studies on thyroxine turnover in Jamaicans subjects. The decrease in plasma radioactivity following intravenous injection of labelled T4 has two components. The slow component lasting from 1 to 10 days post injection may be mathematically analysed to give the following data: (a) thyroxine distribution space; (b) total extra thyroidal thyroxine; (c) fractional turnover rate of the hormone and (d) thyroxine secretion rate. The results obtained in six normal Jamaican subjects agree well with those found by workers in North America and Europe. The fast component (10 minutes to 4 hours post injection) has been analysed in 8 normal, 2 hypothyroid and 1 thyrotoxic subjects using simultaneously injected albumen 125I and thyroxine 131I. This technique has previously been used by Oppenheimer et al (1967). It has until recently been thought that the cellular uptake of thyroxine was dependent on the concentration of diffusible (non protein bound) thyroxine in plasma. The results presented here show cellular uptake values 100 times greater than can be explained on this basis. These data have been analysed by a computer programme designed by Dr. J. B. Shepherd, Department of Physics, U.W.I. (AU)

Reassessment of thyroid function in euthyroid Jamaicans

In 1964 Goldberg et. a.l reported the results of a thyroid function study in a large group of normal Jamaicans. Very low 24 hour thyroidal uptakes of I131 were obtained, the mean being 13.8 percent of the dose. In view of these findings thyroid function was reassessed in 32 euthyroid Jamaican subjects. Investigations performed included, estimation of plasma inorganic iodide, 2, 4, and 24 hour thyroidal uptakes of radio iodide, absolute thyroidal iodide uptake and thyroidal and renal clearances of plasma iodide. Results obtained in all these investigations agreed well with those found in temperate climates and are at variance with the findings of Goldberg et al (AU)

Preliminary report on hyperprolactinaemia in Trinidadian women: prevalence, clinical and endocrine features - abstract

Since the development of a reliable method of assay for prolactin, it has become widely accepted that disorders of prolactin secretion constitute the most common disorder of hypothalamic/pituitary function. Ninety female patients with serm prolactin concentrations above 40ng/ml (normal 0 - 14 ng/ml) over a one-year period were reviewed. The mean age of presentation was 31 years (range 16 -54). Of the 90 patients, 60 percent were Negro, 36 percent East Indian and 4 percent mixed. The commonest presenting complaints were (86 percent), galactorrhoea (68 percent) and hirsutism (57 percent). Fourteen patients had radiological evidence of tumour; all these had prolactin levels greater than 100ng/ml (range 121 - 895ng/ml) and 60 percent had LH/FSH ratios of less than 1.00. Over the last three years, requests for prolactin assays have increased markedly. During the period June 1984 to July 1985, 1,030 assays were done of which 20 percent were above 40ng/ml. This trend reflects an increased awareness of the importance of this condition (AU)

Combination chemotherapy in the management of lymphoma - abstract

This preliminary report describes our experience with a modification of MOPP regime (nitrogen mustard, vincristine, prednisone and procarbazine) in 21 patients with advanced (Stage III and IV) malignant lymphoma. Six patients had Hodgkin's disease; 9 lymphosarcoma; and 4 reticulum cell sarcoma. The desease was unclassifiable in 2 cases. There were 6 fatalities, none of which could be attributed to therapy. Several side effects of therapy occurred but none of these were serious. Seven patients defaulted for a variety of reasons. Eight patients are still undergoing treatment and 3 of these are at present in remision. The number of patients is at present too small for any firm conclusions to be drawn, but it is probably worthwhile continuing with this form of therapy. However, careful selection of patients is essential, particularly because of the high rate of default (AU)

Thyroid function in euthyroid Jamaicans

Thyroid function has been investigated in 32 hospitalized euthyroid Jamaicans. The in vivo investigations performed were measurement of 2«, 4 and 24 hr thyroidal uptake of 131I, thyroidal and renal clearances of radioiodide, absolute iodide uptakes and, in 6 subjects, radiothyroxine turnover studies. Thyroxine binding globulin and prealbumin capacities were measured in a small number of cases. Results obtained in all these investigations agreed well with those found in temperate climates and are at variance with previous finding of low 24 hr thyroidal uptakes of 131I in euthyroid Jamaicans, associated with a normal serum protein-bound iodine.(AU)

Clonal evolution in two patients with autoimmune disease and lymphoreticular neoplasia

Two cases are described, one with proven lymphosarcoma and doubtful autoimmune disease, and the second with the reverse situation, in which circulating abnormal mononuclear cells showed PHA responsiveness and an abnormal chromosomal constitution (clonal evolution). These findings are discussed in the light of previous cytogenic studies of lymphoreticular neoplasia and autoimmune disease and the relationship between these two conditions (Summary)

Hyperinfection syndrome with Strongyloides stercoralis in malignant lymphoma

Hyperinfection with Strongyloides stercoralis occurred in three patients with malignant lymphoma. The probable cause was alteration of the immune responses either as a result of the malignant lymphoma or by the treatment given. Though thiabendazole (Mintezol) has produced reasonable results in the treatment of the hyperinfection syndrome, preliminary data suggest that the new broad-spectrum antihelmintic levamisole (Ketrax) is more effective. All patients who live or have lived in an area where strongyloidiasis is endemic should be investigated to detect the presence of the nematode before and during treatment with drugs with immunosuppressive properties. In view of the high mortality with S. stercoralis hyperinfection, vigorous therapy should be instituted before the use of immunosuppressive drugs (Summary)

Mongolism, thyrotoxicosis and diabetes mellitus

A case of mongolism, thyrotoxicosis and diabetes mellitus is reported. The literature on the status of the thyroid in mongolism is reviewed. Attention is drawn to the association of mongolism, thyrotoxicosis and diabetes mellitus, and a possible explanation for their association is discussed (AU)

The binding characteristics of transcortin, thyroxine binding globulin and pre-albumin in Jamaicans

The binding characteristics of Thyroxine Binding Globulin(TBG) Pre-albumin (TBPA) and Transcortin in Jamaicans were found to be similar to those described elsewhere. The previously reported diminution in adrenocortical and thyroidal function associated with normal plasma cortisol and thyroxine levels cannot therefore be ascribed to an increase in the plasma protein binding of these hormones (AU)