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1.
West Indian med. j ; 50(1): 78-80, Mar. 2001. ilus
Artigo em Inglês | MedCarib | ID: med-311

RESUMO

The case of a 25-year old woman with recurring and metastasizing clear cell sarcoma of parts (CCS) is presented. The clinical setting and pathological apperance were in agreement with the original cases described. This report serves to highlight the clinico-pathological features of this rare and aggressive malignancy with specific reference to prognostic markers and treatment. (AU)


Assuntos
Adulto , Relatos de Casos , Feminino , Humanos , Sarcoma de Células Claras/patologia , Neoplasias de Tecidos Moles/patologia , Sarcoma de Células Claras/tratamento farmacológico , Neoplasias de Tecidos Moles/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Imuno-Histoquímica , Valor Preditivo dos Testes , Prognóstico
2.
West Indian med. j ; 49(2): 148-53, Jun. 2000. tab, gra
Artigo em Inglês | MedCarib | ID: med-805

RESUMO

The study objective was to describe morbidity and mortality from HIV infection and the acquired immunodeficiency syndrome (AIDS) in Guadeloupe from 1998 to 1997 and to evaluate survival and prognostic factors. The HIV infected patients database of Guadeloupe included 1771 adult patients up to December 31, 1997. Annual incidence of AIDS defining illnesses were calculated and compared using Poisson regression. Survival analysis with log-rank test and multivariate analysis with Cox's model were performed for patients with AIDS. At the end of December 1997, 599 cases of AIDS (33.8 percent) and 367 deaths (20.7 percent) were reported. For 32.1 percent of the patients, AIDS was diagnosed before inclusion. Incidence of most AIDS-defining events decreased over time, especially after the introduction of protease inhibitor therapy. Before the introduction of protease inhibitors in September 1996, overall median survival after AIDS was 11.8 months (95 percent Confidence Interval (CI), 95 percent CI 10.2 - 14.1.) After this date median survival increased to 17.8 months (95 percent CI 18.6 - 22.5 ) and probability of survival was significantly higher for patients treated with protease inhibitor in combination regimen (mean 19.0 months. Standard deviation (SD) 1.3) compared to those who were not (mean 7.9 months, SD 0.6, p<0.0001). Prognosis factors of death after AIDS were older age (Relative Hazard, RH : 1.17, 95 percent CI 1.07 - 1.28), occurrence of two or more AIDS-defining events at the beginning of the disease (RH: 1.70, 95 percent CI 1.32 - 2.19), and a CD4 cell count less than 50/mm3 (RH: 2.33, 95 percent CI 1.71- 3.17). On the other hand, occurrence of AIDS during follow-up had a better prognosis (RH : 0.68, 95 percent CI 0.52 - 0.89) and protease inhibitor therapy was strongly associated with a longer survival (RH 0.26, 95 percent CI 0.13 - 0.53). We concluded that HIV infection in Guadeloupe was frequently diagnosed at the stage of AIDS. However, survival of patients and trends of major AIDS defining illnesses were more similar to the European pattern than to the Caribbean one, as a consequence of the availability of modern therapy.(AU)


Assuntos
Adulto , Feminino , Humanos , Masculino , Adolescente , Síndrome de Imunodeficiência Adquirida/mortalidade , Inibidores de Proteases/uso terapêutico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Guadalupe/epidemiologia , Infecções por HIV/epidemiologia , Estudos Longitudinais , Prognóstico , Modelos de Riscos Proporcionais , Inibidores de Proteases/uso terapêutico , Comportamento Sexual , Análise de Sobrevida , Carga Viral
3.
West Indian med. j ; 49(1): 66-9, Mar. 2000. ilus
Artigo em Inglês | MedCarib | ID: med-1070

RESUMO

One per cent of all brain tumours and twenty per cent of meningiomas eventually develop an extracranial extension. The least common site is the neck. We report a case of malignant meningioma with extension into the neck of a 39-year-old male.(Au)


Assuntos
Adulto , Relatos de Casos , Humanos , Masculino , Meningioma/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias Meníngeas/tratamento farmacológico , Jamaica , Cérebro/patologia , Neoplasias de Cabeça e Pescoço/terapia , Imagem por Ressonância Magnética , Meningioma/terapia , Prognóstico , Tomografia Computadorizada por Raios X
4.
West Indian med. j ; 49(1): 59-60, Mar. 2000. ilus
Artigo em Inglês | MedCarib | ID: med-1073

RESUMO

The ultrasonographic and computed tomography features of four cases of solid and papillary epithelial neoplasm (SPEN) - a rare pancreatic tumour - are described. Although not diagnostic, the presence of these imaging features in the typical clinical setting may permit pre-operative radiological diagnosis and facilitate planning for curative surgery for this malignant tumour which has an excellent prognosis even without further adjuvant therapy.(Au)


Assuntos
Adulto , Feminino , Humanos , Relatos de Casos , Neoplasias Pancreáticas/diagnóstico , Carcinoma Papilar/diagnóstico , Neoplasias Epiteliais e Glandulares/diagnóstico , Jamaica , Biópsia , Pâncreas/patologia , Prognóstico , Tomografia Computadorizada por Raios X , Ultrassonografia
6.
West Indian med. j ; 47(1): 10-4, Mar. 1998.
Artigo em Inglês | MedCarib | ID: med-1634

RESUMO

This paper reviews childhood autism, a serious psychopathological disorder, with emphasis placed on aetiology and management; and outlines briefly the care of the autistic population in a few well organised programmes existing in Jamaica. There is a need for increased awareness, local research and dissemination of information to appropriate personnel and organizations(AU)


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Transtorno Autístico/diagnóstico , Diagnóstico Diferencial , Transtorno Autístico/etiologia , Transtorno Autístico/reabilitação , Educação Especial , Equipe de Assistência ao Paciente , Prognóstico
7.
J Clin Epidemiol ; 50(2): 121-6, Feb. 1997.
Artigo em Inglês | MedCarib | ID: med-2032

RESUMO

AIMS: (1) To estimate the proportion of subjects with homozygous sickle cell disease who have a benign clinical course, and (2) to assess factors that may be predictive of benign disease. MATERIAL: Subjects (n = 280) were participants in a longitudinal cohort study of sickle cell disease. They were classified as benign or control based on clinical history from birth to age 13 years old. Associations with growth, hematology, and an index of social status were investigated. RESULTS: Benign disease occurred in 43 (15 percent) patients. Neither growth nor social status were related to benign disease. There were only two statistically independent association: alpha thalassemia status and average steady state fetal hemoglobin (HbF). Patients with a normal complement of alpha globin genes were 2.2 (1.0, 4.9) times more likely to have frequent painful crises, dactylitis, and bone necrosis. The odds of having benign disease were 1.09 (1.02, 1.17) times higher for each unit increase in HbF, and 44 percent of subjects with HbF in the top decile (HbF > 13.8 percent) of the distribution had benign disease. There was no evidence for a threshold effect of high HbF on benign disease. CONCLUSION: A benign clinical course of sickle cell disease may occur in Jamaica and is associated with a normal alpha globin gene complement, and high levels of HbF. Ability to predict benign disease at birth is limited.(AU)


Assuntos
Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Traço Falciforme/epidemiologia , Traço Falciforme/genética , Deleção de Genes , Estudos de Coortes , Hemoglobina Fetal/análise , Globinas/análise , Homozigoto , Jamaica/epidemiologia , Prognóstico , Classe Social
8.
Kingston; s.n; 1997. viii,62 p. ilus, tab, gra.
Tese em Inglês | MedCarib | ID: med-1171

RESUMO

Cancer of the prostate is a growing concern in both developed and developing countries due to the escalation of the incidence of prostate cancer in recent years. Researchers have identified it as the first or second most common cause of cancer in males in Western countries today. Since age, race, ad family history of disease are recognized risk factors, and since Jamaica is facing the reality of a larger aging population, cancer of the prostate is an issue with public health significance. Prognosis for cure is good with early detection and treatment. An analytical study was done using a pre-tested, 40 item questionnaire which was specifically designed for this study. Between March 27, and April 18, 1997, all the patients with the diagnosis of prostate cancer who attended the two major Urology clinics in the Kingston and St. Andrew area plus patients from three doctors' offices, also in this area, were used as the sample for a total of 33. The data analysis was done using the Epi Info programme and was presented by tables, figures, and narration. The purpose of this study was to explore the impact of prostate cancer on, and coping mechanisms used by, individuals 60 years of age and older, and their families, also to identify availability of community support resources. The study found the number of respondents increased with age. The high cost of health care created an economic burden as most were retired and on fixed incomes. The need for assistance with activities of daily living increased with the duration of the illness. Many expressed feelings of depression and helplessness. Their main coping mechanism was reliance on their doctor for treatment and medication. Cancer of the prostate impinges on the quality of life of our vulnerable aging male population and their families. It threatens their social, economic, and psychological well-being by increasing the strain placed on their limited resources, and the untoward complications of treatment such as urinary incontinence and impotency.(Au)


Assuntos
Idoso , Humanos , Masculino , Neoplasias da Próstata/epidemiologia , Prognóstico , Estudos Transversais , Inquéritos e Questionários , Interpretação Estatística de Dados , Assistência à Saúde/economia , Incontinência Urinária/complicações , Jamaica/epidemiologia
9.
J Pediatr ; 129(3): 443-5, Sept. 1996.
Artigo em Inglês | MedCarib | ID: med-2988

RESUMO

Biliary sludge was observed in the gallbladder in 17 of 429 patients in a cohort study of sickle cell disease. Discrete gallstones later developed in 12 patients, but no stones developed in five patients; one patient with biliary sludge had no change in his condition for 5 years. None of the patients with biliary sludge had any symptoms referable to the biliary tract, and cholecystectomy has not been performed. The Jamaican experience suggests that biliary sludge may be treated conservatively, similar to our approach to asymptomatic gallstone. (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Pré-Escolar , Adolescente , Bile , Anemia Falciforme/complicações , Anemia Falciforme/genética , Colelitíase/etiologia , Talassemia beta/complicações , Talassemia beta/genética , Genótipo , Doença da Hemoglobina SC/complicações , Doença da Hemoglobina SC/genética , Homozigoto , Prognóstico
10.
Acta Paediatr ; 85(6): 666-9, Jun. 1996.
Artigo em Inglês | MedCarib | ID: med-2073

RESUMO

Height-for-age and weight-for-height are commonly used indicators of nutritional status; however, their precise interrelationship remains unclear. We examined the relationship between weight-for-height and linear growth in 127 stunted Jamaican children aged 9 - 24 months. The children were measured every 6 months over a 2 year period. The initial weight-for-height status was positively associated with linear growth in the following 6 month interval. The change in weight-for-height in the preceeding interval was better predictor of linear growth in linear growth in the next interval than attained weight-for-height at the beginning of the interval. The results suggest that variations in weight-for-height may influence the rate of linear growth.(AU)


Assuntos
Feminino , Humanos , Lactente , Masculino , Transtornos da Nutrição Infantil/diagnóstico , Insuficiência de Crescimento/diagnóstico , Crescimento , Avaliação Nutricional , Desnutrição Proteico-Calórica/diagnóstico , Síndrome de Emaciação/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Análise de Regressão , Estudos Longitudinais , Estatura , Peso Corporal , Fatores Etários
11.
WEST INDIAN MED. J ; 45(1): 37-8, Mar. 1996.
Artigo em Inglês | MedCarib | ID: med-4683

RESUMO

Metastic carcinoma of the penis is uncommon. The primary tumour is most commonly reported to be in the genitourinary or gastrointestinal tract. A case of metastatic carcinoma of the penis, secondary to a primary carcinoma of the prostate gland, is described (AU)


Assuntos
Relatos de Casos , Idoso , Humanos , Masculino , Neoplasias Penianas/secundário , Neoplasias da Próstata/patologia , Adenocarcinoma/patologia , Prognóstico
12.
Leukemia Lymphoma ; 23: 561-5, Mar. 11, 1996.
Artigo em Inglês | MedCarib | ID: med-2049

RESUMO

We describe the clinical and pathological features of 23 Afro-Caribbean patients with adult T-cell leukaemia/lymphoma admitted to the Queen Elizabeth Hospital, Barbados over a 5 year period. There were 9 males and 14 females, with a median age of 38 years (range 14-84). Twelve had acute leukaemia, 10 lymphoma (including 4 with solitary extra nodal lesions) and 1 smouldering subtype. Two patients had a past history of tropical spastic paraparesis/HTLV I associated myelopathy (TSP/HAM). The prognosis was poor, with only 3 complete responses to chemotherapy (CHOP) lasting from 9 to 36 months. We conclude that ATLL in Barbados is similar to the disease in other Caribbean islands and Japan, except that in Barbados the age of onset is over a decade younger than in Japan.(AU)


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma de Células T do Adulto/patologia , Leucemia-Linfoma de Células T do Adulto/imunologia , Leucemia-Linfoma de Células T do Adulto/transmissão , Barbados , Prognóstico , Estudos Prospectivos
13.
BMJ ; 311(7016): 1325-8, Nov. 1995. tab
Artigo em Inglês | MedCarib | ID: med-3606

RESUMO

OBJECTIVES - to compare the course and outcome of psychotic illness in a group of Afro-Caribbean patients resident in the United Kingdom and a group of white British patients. DESIGN - cohort study of consecutive admissions followed up for four years. SUBJECTS - 113 patients with psychotic illness of recent onset admitted to two south London hospitals. MAIN OUTCOME MEASURES - course of illness, history of self harm, social disability, treatment received, and hospital use adjusted for socioeconomic origin. RESULTS - the Afro-Caribbean group spent more time in a recovered state during the follow up period (adjusted odds ratio 5.0; 95 percent confidence interval 1.7 10 14.5), were less likely to have had a continuous illness (0.3; 0.1 to 0.8), were less at risk of self harm (0.2; 0.1 to 0.8), and were less likely to have been prescribed antidepressant treatment (0.3; 0.1 to 0.9). There were no differences in hospital use, but the Afro-Caribbean group had more involuntary admissions (8.9; 2.1 to 35.6) and more imprisonments over the follow up period (9.2; 1.6 to 52.3). CONCLUSIONS - Afro-Caribbean patients in the United Kingdom have a better outcome after psychiatric illness than do white people. The combination of high incidence and more benign course of illness of psychotic illness in this group may be due, at least in part, to a greater exposure to precipitants in the social environment. (AU)


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/etnologia , Idade de Início , Estudos de Coortes , Estudos Transversais , Londres , Estudos Longitudinais , Prognóstico , Estudos Prospectivos , Classe Social , Fatores Socioeconômicos , Região do Caribe/etnologia
14.
West Indian med. j ; 44(3): 85-7, Sept. 1995.
Artigo em Inglês | MedCarib | ID: med-5887

RESUMO

Idiopathic focal and segmental glomerulosclerosis (IFSGS) in a predominantly black population does not appear to behave any differently than in Caucasian patients. Response to steroid therapy and cyclophosphamide had favourable prognostic significance. There may be a subgroup of IFSGS which responds more slowly to steroids. The duration of steroid therapy should extend beyond four months (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Glomerulosclerose Segmentar e Focal/epidemiologia , Ciclofosfamida/uso terapêutico , Evolução Fatal , Prognóstico , Esteroides/uso terapêutico
15.
West Indian med. j ; 43(3): 104-6, Sept. 1994.
Artigo em Inglês | MedCarib | ID: med-7754

RESUMO

Three cases of spinal epidural abscess managed at the University Hospital of the West Indies are presented. This disorder, a neurosugical emergency, runs a variable course, and, if improperly managed, may lead to paraplegia and death. The aetiology, diagnosis and management of this disease are discussed (AU)


Assuntos
Humanos , Adulto , Masculino , Abscesso/diagnóstico , Abscesso/terapia , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/terapia , Laminectomia , Emergências , Prognóstico
16.
West Indian med. j ; 43(3): 89-92, Sept. 1994.
Artigo em Inglês | MedCarib | ID: med-7758

RESUMO

A retrospective analysis of 26 children with neuroblastic tumours treated at the University Hospital of the West Indies (UHWI) between 1970 and 1991 was undertaken to evaluate factors affecting prognosis. The peak incidence was between 48 months and 60 months of age, and 75 percent of the deaths occurred in children older than 3 years. The abdomen was the most common site of the tumours 79 percent of which were from the adrenal gland and carried a dismal outcome. Other sites were thoracic, pelvic and cervical. Extra-adrenal tumours have a good outcome even when the histology is unfavourable; 92 percent of the tumours were in Stages III or IV at the time of initial presentation. Stage IV disease accounted for all but one of the deaths. Of the 8 children with favourable histology (ganglioneuroma or well-differentiated ganglioneuroblastoma), only one (12.5 percent) died, whereas of the remaining 18 cases with unfavourable histology (neuroblastoma and undifferentiated ganglioneuroblastoma), eleven (61 percent) died. When managed by surgery alone or with adjuvant chemo- and/or radio-therapy, only 36.4 percent succumbed while all 4 children with chemotherapy only died. Ten children are alive without disease for more than three years post-therapy. A scoring system was designed which takes into account the factors influencing the outcome in neuroblastic tumours, namely, age, location, stage and histological types of the tumours and therapy. All the children with a score of 21 or less survived, whereas all those with scores of 22 or above succumbed. This underlines the multifactorial influences on the final outcome of neuroblastic tumours (AU)


Assuntos
Humanos , Pré-Escolar , Criança , Prognóstico , Neuroblastoma , Neuroblastoma/terapia , Evolução Fatal , Índice de Gravidade de Doença
17.
Mol Neurobiol ; 8(2-3): 149-53, Apr.- June 1994.
Artigo em Inglês | MedCarib | ID: med-5860

RESUMO

This article summarizes the present state of knowledge of TSP/HAM as it is seen in Jamaica. It reviews the historical and clinical aspects of the disease, and shows how the discovery of HTLV-I has generated research in several countries and contributed to a better understanding of the disease. It highlights the need for continued collaboration between basic scientists and clinical neurologists in order that the dilemmas relating to therapy and pathogenicity may be successfully addressed. (AU)


Assuntos
Estudo Comparativo , Paraparesia Espástica Tropical/fisiopatologia , Vírus Linfotrópico T Tipo 1 Humano/patogenicidade , Paraparesia Espástica Tropical/epidemiologia , Paraparesia Espástica Tropical/patologia , Jamaica/epidemiologia , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Prognóstico
18.
West Indian med. j ; 43(4): 134-7, Dec. 1994.
Artigo em Inglês | MedCarib | ID: med-7686

RESUMO

Of the twenty-nine children with solid tumours treated at the University Hospital of the West Indies (UHWI) between January, 1972 and December, 1991, there were twenty-eight cases of nephroblastoma and one of mesoblastic nephroma. Peak incidence was between the ages of two and four years. Twenty-five children had radical nephrectomy while one had bilateral partial nephrectomy. In thirteen cases, pre-operative chemotherapy and radiotherapy was used. Post-operative chemotherapy and radiotherapy were used in 24 and 13 cases, respectively. Stage of the tumour was the most decisive factor influencing the outcome. Whereas there was 100 percent cure rate in Stages I and II, Stage III had only a 55.5 percent survival rate and non of the Stage IV survived. Bilateral (Stage V) tumours are curable if individual tumours are localised, as in one of the two cases. The benign mesoblastic nephroma, in a one-month-old infant, was cured by nephrectomy alone. While the present therapy of radical nephrectomy along with combination chemotherapy is satisfactory for early stages, more aggressive adjuvant therapy is needed for improving the results in Stages III and IV (AU)


Assuntos
Lactente , Pré-Escolar , Criança , Humanos , Masculino , Feminino , Tumor de Wilms , Neoplasias Renais , Tumor de Wilms/diagnóstico , Tumor de Wilms/mortalidade , Tumor de Wilms/terapia , Nefropatias/diagnóstico , Nefropatias/mortalidade , Nefropatias/terapia , Resultado do Tratamento , Estudos Retrospectivos , Prognóstico , Estadiamento de Neoplasias , Nefroma Mesoblástico
19.
West Indian med. j ; 42(4): 147-8, Dec. 1993.
Artigo em Inglês | MedCarib | ID: med-8408

RESUMO

A twelve-year retrospective study of 54 consecutive cases of endometial carcinoma revealed that post-menopausal bleeding was the commonest symptom, and the major associated risk factors were obesity and hypertension. Panhysterectomy was the corner-stone of treatment while adjunctive therapy was based on certain prognostic factors and the operator's preference (AU)


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Feminino , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/terapia , Endométrio , Fatores de Risco , Trinidad e Tobago , Histerossalpingografia , Prognóstico , Estudos Retrospectivos , Menopausa
20.
West Indian med. j ; 41(2): 81-3, June 1992.
Artigo em Inglês | MedCarib | ID: med-9631

RESUMO

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)


Assuntos
Humanos , Adulto , Masculino , Tireotoxicose/diagnóstico , Paralisias Periódicas Familiares/diagnóstico , Paralisias Periódicas Familiares/fisiopatologia , Paralisias Periódicas Familiares/terapia , Prognóstico , Jamaica , Testes de Função Tireóidea , Prognóstico , Tireotoxicose/fisiopatologia
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