Concomitant urothelial cancer and renal tuberculosis.

We report a case of coexisting urothelial cancer and renal tuberculosis in the same kidney. The patient is a 72-year-old female with a remote history of treated pulmonary tuberculosis who presented with haematuria, initial investigation of which elucidated no definitive cause. Almost 1 year later, a diagnosis of metastatic urinary tract cancer was made. The patient received chemotherapy for advanced collecting duct type renal cell carcinoma, based on histological features of renal biopsy. Subsequent confirmatory immunostains however led to a revised diagnosis of urothelial cancer, necessitating a change in chemotherapy regimen. A diagnosis of ipsilateral renal tuberculosis was made based on TB-PCR testing of renal biopsy tissue and anti-TB therapy was coadministered with chemotherapy. The patient died 9 months after diagnosis of metastatic urothelial cancer.

Chronic inflammatory demyelinating polyneuropathy in a patient infected with human T lymphotropic virus type I.

A 32-year-old Afro-Caribbean woman presented with a 1-year history of slowly progressive sensory and motor symptoms initially affecting the legs and later involving the arms. Clinical examination demonstrated a mainly distal pattern of weakness with little objective sensory impairment. The clinical features suggested the possibility of chronic inflammatory demyelinating polyneuropathy. This diagnosis was supported by neurophysiological testing and examination of the cerebrospinal fluid and confirmed by sural nerve biopsy as well as by exclusion of other causes of neuropathy. Seropositivity for human T lymphotropic virus type I (HTLV-I) was demonstrated. The clinical significance of this finding in an area with a high HTLV-I endemicity, as well as its possible aetiological relevance to the diagnosis of chronic inflammatory demyelinating polyneuropathy, is discussed.

Struma cordis in a Jamaican woman.

A case of ectopic thyroid within the right ventricle (struma cordis) occurring in a middle-aged Jamaican woman is described. This rare and fascinating condition is curable utilizing standard open-heart surgical techniques. Investigations to rule out primary thyroid or ovarian malignancy, as well as the presence of remaining normal thyroid tissue or other ectopic thyroid rests are important in the management of these patients.

Berry aneurysms of the circle of Willis: results of an autopsy study at the University Hospital of the West Indies

A detailed study of berry aneurysms of the Circle of Willis, in a consecutive autopsy series, was conducted at the University Hospital during the 10-year period 1973 to 1982. There were 70 patients with berry aneurysms in a total of 3,650 autopsies, giving a prevalence of 1.9 percent. Of 70 cases, 66 had ruptured, all of which were fatal. In 75 percent of cases, the diagnosis was made at post-mortem. Sixty percent of patients had associated hypertension. Physical stress did not appear to be a precipitating factor in causing rupture. Aneurysms occurred equally in men and women but multiple aneurysms occurred most commonly in elderly hypertensive women. The peak age at occurrence was in the third and fourth decades. The majority of aneurysms (91 percent) were located in the anterior circulation, and 37 percent of those that had ruptured were situated in the middle cerebral artery. The results of our study are similar to those found in other autopsy series, thus defying the general opinion that berry aneurysms are uncommon in our population since many of the cases were undiagnosed during life (AU)

Asymptomatic microadenomas of the pituitary gland in an unselected autopsy series

Three hundred and fifty pituitary glands were studied in an selected autopsy series. The ages of the cases ranged from newborn to 104 years. None had clinical manifestations of pituitary dysfunction. Thirty-five glands (10 percent) showed 40 microadenomas which were distributed equally among males and females, occuring most frequently in the 8th decade. The clinical and autopsy records and X-ray films of the patients with microadenomas were reviewed. Of these, 50 percent were hypertensive, 20 percent were known diabetics and 14 percent were mildly to moderately obese. Two of the eight available X-ray films showed minor abnormalities of the sella turcica. The tumours were less than 5 mm in diameter and half of them were located away from the periphery of the gland. The findings were compared with those of other series (AU)

Crippling giant keloid

Keloids occur commonly in dark-skinned races on the face, the neck and the front thorax. One such patient, a Negro man aged 50, in whom an unusually large tumour-like keloid caused disability, disfigurement and social seclusion, was seen at University Hospital of the West Indies. He was wheeled into the surgical clinic supporting in his lap a large mass wrapped in dressing, hanging from his chin. He was unable to move his head sideways because of the heavy object dragging on his neck (AU)

Large calcified right atrial myxoma in a newborn: rare cause of neonatal death

A newborn baby girl presented at birth with severe cyanosis, congestive cardiac failure, and an ischaemic leg ulcer, and died within 10 hours of birth. Necropsy disclosed a large haemorrhagic, calcified right atrial myxoma obstructing the tricuspid valve (AU)

Ulnar nerve abscess in hansen's disease

A case of abscess formation in a large peripheral nerve in a patient with leprosy is presented. The pathogenesis of such lesions is discussed and the rarity in the local community is emphasized (AU)

Intramedullary schwannoma of the spinal cord

A rare case of solitary, dorsally located, intramedullary schwannoma of the thoracic spinal cord is reported in a 54-year-old man. The pathogenesis of the tumour in the location is discussed (AU)

Midline communicating spinal extradural arachnoid cyst

A case of communicating spinal extradural arachnoid cyst arising from the thoracic midline dural defect is reported in a 17-year-old lad. The condition is a rare cause of spinal cord compression, and usually presents with progressive spastic paraparesis in adolescence. Fifty-eight per cent of the cases reported are of the communicating type. Myelography establishes the diagnosis if the cysts can be filled with contrast medium. Surgical removal of the cyst and obliteration of the communication usually leads to prompt improvement in neurological symptoms (AU)

Intrasellar abscess simulating a pituitary tumour

A case of an abscess of the sella turcica discovered during craniotomy for pituitary tumour in a 20-year-old man is presented. The clinical features of this unusual intrasellar lesion are discussed. The importance of early diagnosis, high-dosage antibiotics and surgical intervention in reducing the high mortality associated with abscesses in this location are emphasized. It is suggested that abscess of the sella turcia should be considered in the differential diagnosis of a sella mass in any patient with a recent history of cerebrospinal fluid rhinorrhea, sphenoid sinusitis or meningitis (AU)

Tuberculous encephalopathy. A rare complication of pulmonary tuberculosis

A case of tuberculous encephalopathy, a rare form of neurotuberculosis, is reported in a 16-year-old girl who had pulmonary tuberculosis and extensive cerebral demyelination. The clinical, laboratory and pathological features of this entity are highlighted and the pathogenesis discussed.(Au)

Major causes of death in diabetic patients at the University Hospital of the West Indies: an autopsy study

Diabetes mellitus is one of the more common chronic diseases in Jamaica. To determine the major causes of death in diabetics, a retrospective autopsy study was undertaken, as autopsy reports provide the most precise explanation of the cause of death. At the University Hospital of the West Indies (UHWI) between January 1991 and July 1997, autopsies were performed on 1695 patients, of which 142 (8.4 percent) had diabetes mellitus. There were 61 males (43 percent) and 81 females (57 percent), ranging in age from 25 to 93 years. The major causes of death in these diabetics were infection (34.5 percent), and vascular diseases (19.7 percent), which included cardiovascular diseases (11.3 percent), cerebrovascular diseases (5.6 percent), and other vascular disorders (2.8 percent). Biochemical derangement accounted for 15.5 percent of deaths, comprising uncontrolled diabetes with or without ketoacidosis or coma (13.4 percent) and uraemia (2.1 percent). Pulmonary thromboembolism (6.3 percent), gastrointestinal diseases (6.3 percent), trauma/homicide/suicide (3.5 percent), neoplasms (2.8 percent), acute pancreatitis (2.1 percent), and liver disease (0.7 percent) were other causes. In 12 caes, the cause of death was undetermined.(AU)

An appraisal of smear diagnosis in neurosurgical biopsies - abstract

The neurosurgeon needs rapid tissue diagnosis during surgery to plan the extent of the operation if the exact nature of the lesion is known, to take additional specimens if a previous attempt has failed to be diagnostic and to decide on management if the lesion is non-neoplastic. Rapid tissue diagnosis is mostly offered by frozen sections in various fields of surgery. However, neuro-surgical biopsies are generally multiple, tiny fragments of gelatinous tissue, mostly inappropriate for frozen sections. Smear technique for tissue diagnosis has been in use since 1930 and is routinely used for neurosurgical diagnosis in many European centres. It was started at the University Hospital of the West Indies in 1981. To evaluate the accuracy of the technique we analyzed smear diagnoses and compared them with paraffin section diagnoses. The results were compared with similar studies from other parts of the world. One hundred and forty-four biopsies, comprising 133 intracranial and 11 spinal biopsies, were analyzed. The correct diagnosis was made in 93 percent of cases. The conditions encountered were mainly neoplastic. In 10 cases, there were discrepancy between smear and paraffin section diagnosis. In 8 of the 10 cases, the error was in properly classifying the tumour and did not have any immediate significance on the management. Only in two cases could the error have had a management implication. There was no false negative and only one false positive when a meningioma was diagnosed on superficial biopsy material and on subsequent analysis of more specimen proved to be an inflammatory pseudo-tumour. The diagnostic accuracy (93 percent) was in keeping with similar studies from Europe and North America. The technique is simple, rapid, sensitive, accurate and appropriate for rapid diagnosis of neurosurgical biopsies. (AU)

Tuberculous encephalopathy: a rare complication of pulmonary tuberculosis

A case of tuberculous encephalopathy, a rare form of neurotuberculosis, is reported in a 16-year-old girl who had pulmonary tuberculosis and extensive cerebral demyelination. The clinical, laboratory and pathological features of this entity are highlighted and the pathogenesis discussed.

Correlation between clinical and autopsy diagnosis at the University of the West Indies

Autopsies help in the understanding of the disease process, check the accuracy of clinical diagnosis and provide reliable data for the epidemiologist. Although the number of comparative autopsy studies is very limited, the rate of discrepancy between clinical and autopsy ranges from 4 to 68 per cent. To determine the discrepancy between clinical and autopsy diagnoses, and to find out the major disease groups where the errors are most frequently made, a preliminary study was undertaken. One hundred and seventy-eight consecutive autopsies at the University Hospital of the West Indies over an eighteen month period were analysed and the results were compared with similar studies from other institutions. The overall rate of major discrepancy was 16 percent. The most frequently missed diagnoses were thromboembolism (40 percent), followed by malignancies (25 percent) and infection (22 percent). Sickle-cell disease made a special group. In the majority of the sicklers there was no anatomical cause of death, neither was there a clinical diagnosis as to the cause of death. The overall discrepancy rate and the rate of error in major groups in this study is lower than in other similar studies (AU)

Portal vein thrombosis in a child with homozygous sickle-cell disease

A 13-year old boy with homozygous sickle-cell (SS) disease died suddenly at home folllowing a short history of abdominal pain. Autopsy revealed venous thrombosis of the hepatic, portal, superior mesenteric and splenic veins. Venous thrombosis is rare in SS disease and thrombosis of mesenteric vessels is most frequently seen in chronic myeloproliferative disorders. Its occurrence in SS disease raises the possibility of a common pathogenesis and adds another pathology to the causes of abdominal painful crisis. (AU)

Neurofibromatosis of the cervix uteri

A 25-year-old female with von Recklinghausen's neurofibromatosis presented with symptoms suggestive of carcinoma of the cervix. She was, however, found to have neurofibromas of the cervix uteri which accounted for her symptoms. There was also involvement of one or the other system (AU)

Polymyositis at the University Hospital of the West Indies

This paper highlights the similarities and differences between cases of polymyositis seen at the University Hospital of the West Indies (U.H.W.I.) and those reported elsewhere, and reviews the clinical and pathological features of 35 biopsy-proven cases seen over a ten-year period. Such a study has not been previously carried out in the West Indies. The patients' ages ranged from 5 to 73 years with most of the cases in the age range 31-45 years. The sex ratio was 28 females to 7 males (F:M=4:1). The only associated malignancy was a tongue cancer which was resected eight years prior to the development of polymyositis (AU)

Massive congenital intracranial teratoma: report of a case in an hydrocephalic foetus

A large intracranial teratoma which replaced the entire brain is described in an hydrocephalic foetus which was aborted at the 25th week of gestation. This very rare condition is reported for the first time in the Caribbean literature (AU)