Assessment of the influence of HLA class I and class II loci on the prevalence of keloid disease in Jamaican Afro-Caribbeans.

Keloid disease (KD) is a common abnormal cutaneous fibrotic disorder of unknown aetiopathogenesis. KD is reported to have a strong genetic component as it is often familial and has a high incidence in certain ethnicities, in particular those of Afro-Caribbean origin. Genetic risk factors combined with aberrant lesional inflammatory responses point to the human leukocyte antigen (HLA) system as a viable target for investigating disease aetiology. Sequence specific primer polymerase chain reaction with allele sequencing was used to determine HLA-DQA1 and DQB1 allele frequencies (AF) for 165 KD patients and 119 healthy controls of black Jamaican Afro-Caribbean origin. HLA class I alleles A*01, A*03, A*25, B*07 and Cw*08:02, previously identified as KD associated in a different ethnicity, were also analysed. Allele sequencing confirmed typing accuracy but no statistically significant differences in AF were identified between KD patients and controls. Furthermore, KD subgroups including patient gender, family history and multiple- or single-site scarring did not show significant allele-disease associations.

Association of HLA-DRB1* and keloid disease in an Afro-Caribbean population.

BACKGROUND: Keloid disease (KD) is a fibroproliferative dermal tumour of unknown aetiology. The high incidence of familial clustering in KD, its prevalence in certain races and its concordance in identical twins suggest a strong genetic predisposition to keloid formation. The highest incidence of keloids is found in black populations, where the incidence has been estimated to be up to 16%. The most polymorphic genetic system in vertebrates is the major histocompatibility complex (MHC) also known as the human leucocyte antigen (HLA) system. The MHC has been shown to be strongly associated with numerous conditions. Of particular relevance is the association of DR2 with dermal fibrotic diseases including sarcoidosis and systemic sclerosis. AIMS: To investigate the aetiology of KD and the potential involvement of the MHC. METHODS: We compared the HLA-DRB1 phenotype frequencies of Afro-Caribbean patients of Jamaican origin with keloid scars against those seen in a control population of the same ethnicity (n = 121; mean age 34.8 years, range 14-88). In total, 180 keloid cases of Afro-Caribbean origin, recruited from Kingston, Jamaica, were evaluated in the study (mean age 29.7 years, range 2-90 years). HLA-DRB1 alleles were determined in all participants using a semiautomated typing system of reverse hybridization PCR with sequence-specific oligonucleotide probes. HLA-DRB1* phenotype frequencies were established in the Jamaican Afro-Caribbean population and comparisons made between cases and controls. Furthermore, the influence of multiple vs. single lesions, patient gender and family history were also investigated. RESULTS: Differences were observed between the disease and control cohorts although none was significant. CONCLUSIONS: This study does not support an association between HLA-DRB1* alleles and susceptibility to keloid in people of Afro-Caribbean origin.

Extravasation injuries / Lesiones por extravasación

OBJECTIVES: To evaluate the time and type of treatment following extravasation from intravenous infusion and the sequelae of the injuries. METHOD: The charts of 12 patients who were referred to the Plastic and Orthopaedic Services at the University Hospital of the West Indies were reviewed. The study period was between May 2003 and January 2007. Data were collected on age, gender, site of extravasation, extravasated agent, treatment of the extravasation, necrosis interval, duration of hospital stay for treatment of injury and whether the intravenous line was resited and at what site in relation to the injury. RESULTS: The age of patients ranged from three days to 67 years. The female-to-male ratio was 2 : 1. In five patients, the intravenous infusion was discontinued immediately after the swelling was noticed. In two patients, the intravenous infusion was stopped after seven hours and in five patients it was discontinued within 12 to 22 hours. The necrosis interval ranged from 12 hours to three weeks. Immediate treatment following extravasation and discontinuation of the infusion included limb elevation in three patients and application of cold compresses in one patient. Eleven patients developed skin necrosis of varying severities. There was no skin necrosis in one patient. Ten patients spent an average of 31 extra days in hospital for treatment of the extravasation injury. Two patients were treated in an out-patient clinic. CONCLUSIONS: Extravenous leaks can cause severe tissue injuries. Morbidity is increased by delay in recognition and treatment of the extravasation. A protocol for the treatment of extravasation is recommended.

OBJETIVOS: Evaluar el tiempo y tipo de tratamiento tras la extravasación de una perfusión intravenosa y las secuelas de las lesiones. MÉTODO: Se revisaron las historias clínicas de 12 pacientes que fueron remitidos a los Servicios de Ortopedia y Cirugía Plástica del Hospital Universitario de West Indies. El periodo del estudio tuvo lugar entre mayo de 2003 y enero de 2007. Los datos fueron recopilados en relación con edad, género, lugar de la extravasación, agente extravasado, tratamiento de la extravasación, duración del intervalo de necrosis, duración de la permanencia en el hospital para el tratamiento de la lesión, y reubicación o no de la línea intravenosa, así como la especificación de su lugar en relación con la lesión. RESULTADOS: La edad de los pacientes fluctuó de tres días a 67 años. La proporción hembra/varón fue de 2:1. En cada uno de los casos, una sustancia capaz de causar la necrosis se había infiltrado por goteo en el tejido subcutáneo a partir de una perfusión intravenosa. En cinco pacientes, la perfusión intravenosa fue discontinuada inmediatamente después de que se observó la inflamación. En dos pacientes, la perfusión intravenosa fue detenida después de siete horas y en cinco pacientes fue discontinuada dentro de 12 a 22 horas. El rango de intervalo de la necrosis fue de 12 horas a tres semanas. El tratamiento inmediato tras la extravasación y el cese de la perfusión incluyeron la elevación de miembros en tres pacientes y la aplicación de compresas frías en un paciente. Once pacientes desarrollaron necrosis cutánea de diversos grados de severidad. No hubo necrosis cutánea alguna en un paciente. Diez pacientes pasaron un promedio de 31 días extras en el hospital para el tratamiento de la lesión de la extravasación. Dos pacientes fueron tratados en una clínica ambulatoria. CONCLUSIONES: El goteo extravenoso puede causar lesiones severas del tejido. La morbosidad aumenta con la demora en el reconocimiento y tratamiento de la extravasación. Se recomienda un protocolo para el tratamiento de la extravasación.

Extravasation injuries.

OBJECTIVES: To evaluate the time and type of treatment following extravasation from intravenous infusion and the sequelae of the injuries. METHOD: The charts of 12 patients who were referred to the Plastic and Orthopaedic Services at the University Hospital of the West Indies were reviewed. The study period was between May 2003 and January 2007. Data were collected on age, gender, site of extravasation, extravasated agent, treatment of the extravasation, necrosis interval, duration of hospital stay for treatment of injury and whether the intravenous line was resited and at what site in relation to the injury. RESULTS: The age of patients ranged from three days to 67 years. The female-to-male ratio was 2:1. In five patients, the intravenous infusion was discontinued immediately after the swelling was noticed. In two patients, the intravenous infusion was stopped after seven hours and in five patients it was discontinued within 12 to 22 hours. The necrosis interval ranged from 12 hours to three weeks. Immediate treatment following extravasation and discontinuation of the infusion included limb elevation in three patients and application of cold compresses in one patient. Eleven patients developed skin necrosis of varying severities. There was no skin necrosis in one patient. Ten patients spent an average of 31 extra days in hospital for treatment of the extravasation injury. Two patients were treated in an out-patient clinic. CONCLUSIONS: Extravenous leaks can cause severe tissue injuries. Morbidity is increased by delay in recognition and treatment of the extravasation. A protocol for the treatment of extravasation is recommended.

Keloid disease: clinical relevance of single versus multiple site scars.

Much of our current understanding of keloid disease (KD) is based on anecdote rather than objective observation and statistical analysis. To elucidate further the aetiology of KD, we compared the profiles of patients with single versus multiple anatomical site keloid scars. We studied the clinical characteristics of 211 cases of keloid scarring, 137 (65%) females and 74 (35%) males. There were 122 cases with scars in single anatomical site and 89 cases with 369 scars in multiple anatomical sites entered into the study. Patients were of Afrocaribbean origin that presented to the department of Plastic and Reconstructive Surgery at the University of West Indies in Kingston, Jamaica. A total number of 491 keloid scars (single and multiple sites) were evaluated in the study. Data were collected on multiple parameters. The association of age of onset, anatomical area, cause of scarring, sex of the patient, presence or absence of family and medical history in patients with single as opposed to multiple site keloid scars were examined in detail and statistically evaluated. The formation of keloid scars in multiple anatomical sites was found to be statistically significant in that it was more common in younger age groups (p < 0.001) and in females (p < 0.001). Previous medical history, including other fibrotic disorders, was not statistically associated with development of keloid scars in multiple anatomical sites (p > 0.05). More than 50% (111) of all keloid cases had a positive family history of keloid scarring, and family history was strongly associated with the formation of keloid scars in multiple sites as opposed to a single anatomical site (p < 0.002). We conclude that in this particular study group female sex, younger age at presentation and the presence of a positive family history were associated with the development of keloid scars in multiple anatomical sites in Afrocaribbean individuals. This knowledge further emphasizes the need for genetic studies in KD, which may lead to better diagnostic and therapeutic regimes.

Description of site-specific morphology of keloid phenotypes in an Afrocaribbean population.

By examining the keloid scars of 211 Afrocaribbean patients presenting to the Plastic Surgery unit in Kingston, Jamaica, we have described site-specific morphologies of scarring; keloid disease is not a homogenous biological entity. All cases conformed to clinical criteria for diagnosis of keloid scarring: 369 keloid scars were present in 137 females (2-83 years; mean 29.6 years; SD+/-14.9 years) and 74 males (5-90 years, mean 29.5 years; SD+/-15.0 years). Morphologies were specific to each anatomical site: trunk scars (n=45,12.1%) were geometrically shaped with clear margins or irregular in outline, surface and margin; back single scars were well-demarcated botryoid but multiple scars were butterfly-shaped, spheroidal and irregular; chest scars (n=72,20.1%) were butterfly or nonbutterfly shaped found most commonly in the midsternal line; upper limb scars (n=57,15.3%) mostly in the deltoid region (propeller shaped) or elsewhere nodular, linear to irregular; ear (n=85,23%) commonest site being the lobe, having reniform to bulbous shape; face and neck (n=60,16.2%) scars were firm nodular to hard; posterior auricular scars were either horizontal and oblong-shaped or vertical and reniform in outline; scalp scars (n=11,2.8%) were commonest in the occipital area varying from small papules to large plaques; lower limb scars (n=39,10.5%) varied from propeller, butterfly, petalloid to dum-bell-shaped. Three plantar and eight pubic keloids were rare findings. Recognition of different morphological phenotypes is necessary in understanding genotypic predisposition and aiding diagnosis, treatment and prognosis of keloid scars.

Continuous intravenous versus bolus parenteral midazolam: a safe technique for conscious sedation in plastic surgery.

Conscious intravenous sedation is a safe alternative method to general anaesthesia. We have used a technique of continuously titrated, as opposed to incremental boluses of, intravenous or intramuscular midazolam for conscious sedation, with tumescent adrenaline-lignocaine solution for local anaesthesia, routinely in 421 plastic surgical procedures between 1997 and 2000. All patients were American Society of Anesthesiologists (ASA) class I or II. Conscious sedation was administered through our protocol of continuously titrated doses of midazolam in dextrose saline. The operative field was injected subcutaneously with varying volumes of diluted lignocaine and adrenaline, depending on the anatomical region. Preoperative sedation was administered 1 h before the procedure in the form of an intramuscular injection of pethidine and promethazine (Phenergan). Intraoperatively, a subset of patients received up to four divided diluted doses of pethidine. A preoperative 4 h starvation period pronounced the effect of the sedative. No intraoperative conversions to general anaesthesia were needed, and no sedation complications occurred. No unplanned re-admissions secondary to nausea, prolonged drowsiness or pain were required. All patients who were treated using this technique had an uneventful postoperative course. Hospital stay was substantially shorter than following general anaesthesia, which provided a significant reduction in medical-care expenses and a faster return to work. In conclusion, conscious sedation administered by titrated intravenous midazolam is a well-tolerated, safe, consistent, predictable and effective anaesthetic choice for a variety of plastic surgical procedures, many of which would commonly be performed under general anaesthesia.

Failure of bromocriptine therapy to control juvenile mammary hypertrophy.

Rapid massive breast hypertrophy occasionally occurs at the time of puberty or during pregnancy, with breast size eventually becoming burdensome or incapacitating to the patient. Pregnancy-related breast hypertrophy is often arrested or reversed by reducing serum prolactin levels with bromocriptine therapy. Unfortunately, breast enlargement in our 12-year-old patient with massive juvenile mammary hypertrophy was unaffected by bromocriptine therapy despite a reduction of her prolactin to normal levels. Two reduction mammaplasties followed by subcutaneous mastectomy were required to control breast hypertrophy. Breast-tissue hypersensitivity to prolactin appears to be a characteristic of pregnancy-related gigantomastia. Our pubertal patient with juvenile mammary hypertrophy failed to respond to bromocriptine therapy, so the aetiology of this syndrome may involve breast-tissue hypersensitivity to hormones other than prolactin.

Chemical burns as assault injuries in Jamaica.

A three-fold greater incidence of chemical burn injuries in Jamaican hospitals, compared to burn centres in other industrial countries, underscores the problem of the use of common chemicals for assault weapons in this country. With the increased availability of guns for personal use, many Jamaicans learned the value of carrying household chemicals such as sulphuric acid from batteries or sodium hydroxide obtained from cleaning supplies. Chemicals carried in a container, such as one might carry mace, afforded a means of defence among the lower socioeconomic groups who could not afford handguns. This use of dangerous chemicals for defensive weapons has extended to the use of chemicals for assault. The pattern of chemical injury differs significantly from most reports in the literature in both prevalence and aetiology. This review was prepared to examine these injuries with a view to planning strategies for prevention.

Effects of dietary butylated hydroxyanisole and cysteine on toxicity of Lathyrus odoratus to broiler and Japanese quail chicks.

The effect of .75% dietary butylated hydroxyanisole (BHA) and 1% cysteine on the toxicity of Lathyrus odoratus seed to Japanese quail and broiler chicks was examined. In both species, the feeding of Lathyrus seed as a component of a complete diet depressed (P less than .05) body weight gain and feed intake. Typical signs of lathyrism, including ruffled feathers, enlarged hocks, curled toes, ataxia, leg paralysis, and mortality, were observed. Neither BHA nor cysteine exerted protective effects against the lathyrogenic effects. As assessed by mortality, these additives appeared instead to potentiate Lathyrus toxicity.

A new method of resurfacing the lip.

The whole lip can be resurfaced with sensate musculo-mucosal flaps taken from the cheeks. These flaps can be combined with major resection of the whole lip curtain. The return of sensation is of particular benefit to elderly patients who make up the greatest number of patients in the series.

A cage-related foot pad dermatitis in dwarf and normal-sized single comb white Leghorn layers.

Studies were conducted to determine if wire cage floors were involved in producing a foot pad dermatitis in dwarf and normal-sized Single Comb White Leghorn layers. Dermatitis scores were found to be higher for dwarf birds reared in cages versus litter floors. The use of plastic-coated cage floor inserts and wooden perches reduced the incidence of dermatitis in caged dwarf birds. Normal-sized layers consistently exhibited a lower incidence of dermatitis than did dwarf hens.

Effect of several dermatitis preventing agents on foot pad dermatitis in dwarf and normal sized single comb white Leghorn layers.

Studies were conducted to determine the effects of increased dietary levels of vitamin and trace mineral mixtures, methionine, meat and bone meal, fish meal, and safflower oil on foot pad dermatitis in dwarf and normal size Single Comb White Leghorn layers. All layers were maintained in individual wire cages throughout a 40-week experiment period. Individual birds were scored for the incidence of foot pad dermatitis and production parameters were recorded. No significant decrease in the incidence of dermatitis was observed from the following dietary supplements: a 50% increase in a vitamin or a complete trace mineral mixture; a 50% increase in an iron, copper, iodine, and cobalt or a manganese and zinc mixture; .05% methionine; 5% meat and bone meal; 3% herring fish meal; or 2% safflower oil. It was concluded that these mixtures or supplements containing such dermatitis preventative agents as pantothenic acid, zinc, and linoleic acid appeared without effect in minimizing expression of the condition in dwarfs.

Effect of biotin on dermatitis and hatchability in dwarf and normal size single comb white leghorn layers.

Dwarf Single Comb White Leghorn layers were observed to exhibit a marked incidence of cracked skin (dermatitis) on their foot pads and toes when compared to normal size layers, even though both types of layers were on similar rations except that the dwarfs received more methionine. An experiment was conducted to determine the influence of biotin supplementation on dermatitis and hatchability in both types of layers fed rations similar to those fed when the presumed deficiency symptoms were observed. Biotin supplementation did not affect the incidence of dermatitis in either the normals or the dwarfs. Hatchability was satisfactory in both types of layers, and it was significantly higher in the dwarfs, which is contrary to what would be expected if they had suffered from a biotin deficiency.

An observation of dermatitis in caged dwarf and normal-sized Single Comb White Leghorn laying hens.

Dermatitis was observed on the feet of Single Comb White Leghorn hens. Dermatitis scores and score ranges showed lesions to be predominately on the feet of dwarf compared with normal-sized hens. Statistical analysis by log-linear models showed that the percent incidence was closely related to the strains of hen tested and, to a lesser extent, to the type of ration fed the birds.

Anticoccidial drugs and duckling performance to four weeks of age.

Frequently, publications pertaining to waterfowl state that medicated feeds should not be fed to ducklings and goslings. In some localities, producers and hobbyists who raise a small number of ducklings and goslings can purchase only medicated chick, turkey, or gamebird starter and grower feeds. Because of the lack of documented information on this subject and the numerous requests for advice on this matter, anticoccidial drugs, zoalene, sulfaquinoxaline, and amprolium, were mixed in mash feed and fed to Khaki Campbell male ducklings to 4 weeks of age. No significant differences in mean body weight, mortality, and anatomical development were observed among the treatments. Medicated commercial crumble turkey and chick starter feeds produced significantly better feed conversion than the mash medicated or nonmedicated feeds. These differences can be attributed to greater feed spillage with the mash feed. Some ducklings in all treatments showed unsteadiness of gait and shaky legs. These conditions disappeared when the ducklings were moved from the battery brooder to an outside pen. Zoalene, sulfaquinoxaline, and amprolium used at the recommended levels for chickens and turkeys did not cause any leg or anatomical problems in ducklings.

Effect of low salt, sodium, and chloride levels in poult rations on growth, bone development, and related factors.

Two 4-week trials were conducted to determine the role of sodium chloride (salt) on field rickets in poults. A comparison of added dietary salt at 0, .075, .10, .25, and .45% to a corn-soy basal with .103% salt showed significant differences (P less than .05) in body weight gains, blood calcium, magnesium and sodium, feed conversion, and adrenal gland weights among the treatments. Mortality and abnormal bone scores decreased with increasing salt. When sodium was added to the basal diet as a single element for the poults at either 0, .09, .10, .11, and .12%, or chloride at 0, .009, .01, .02, and .03% in comparison to a control group with .20% sodium and .30% chloride, significant differences were found in weekly gain, bone ash, bone breaking strength, tibia weight/body weight, and serum alkaline phosphatase levels between the sodium, chloride, and the combined element groups. Bone abnormality scores decreased with increasing levels of both sodium and chloride in diets.

Distribution of inorganic elements of poultry house dust.

Distribution of inorganic elements was measured in poultry house dust from five types of poultry houses during either winter, spring, or summer. With varied environmental conditions at the time of sampling, the levels of calcium, sodium, iron, zinc, magnesium, and aluminum were higher than the other elements found in dust samples from the five types of poultry houses. The most abundant element in poultry house dust was calcium. The level of this element samples from the mechanically ventilated house used for research purposes corresponded closely to the level found in the feed fed at sampling time. High zinc levels in layer houses may be attributed to either the abrasive actions of feathers and feet of layers against the galvanized wire cages on the high zinc content in feathers. The ash content of dust from the five types of poultry houses ranged from .31 to 3.54%. Air particulate counts for particles ranging in size from .5 to 10 micro meter were much higher in the layer house used for commercial purposes (ranged from 34.9 to 66.3 X 10(6) /m3) than in the layer houses used for research purposes (ranged from 5.8 to 9.8 X 10(6)/m3) than the level during summer (66.3 X 10(6)/m3). The commercial broiler house was dustier than the commercial layer house during the summer.

True metabolizable energy values of corn and different varieties of wheat and barley using normal and dwarf single comb White Leghorn Roosters.

An experiment with four trials was conducted to measure the true metabolizable energy value of corn and different varieties of wheat and barley using normal and dwarf Single Comb White Leghorn (SCWL) roosters. Maxigene, Purple, Red, and Yamhill wheats and corn were assayed for TME using normal sized and dwarf roosters in Trials 1 and 2, respectively. Hannchen, No. 2 Western, Lady Godiva, and Hiproly barleys were assayed using normal sized and dwarf SCWL roosters in Trials 3 and 4, respectively. The pooled results indicated that normal sized roosters gave (P less than .01) significantly higher TME values than dwarf roosters. There was no significant difference in TME found between wheat and barley cultivars, although both types of grain were significantly (P less than .01) lower in TME than the value found for corn. Average dry matter TME values for corn, wheat, and barley were 4.17, 3.70, and 3.54, respectively. A bird x grain interaction was found to be significant (P less than .05).