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)

Endoscopic sclerotherapy of bleeding oesophageal varices in Jamaica

The results of oesophageal sclerotherapy (OS) in 18 patients with recurrent bleeding varices are compared with 15 patients treated medically. The total transfusion requirement pre-sclerotherapy was 112 units of blood (mean 6/patient) which decreased to 46 units (mean 2.5) after sclerotherapy treatment was started (p=0.005). In the medically treated group, total transfusion was 74 units (mean 5 units/patient). One hundred and forty-three injection sclerotherapy sesions were given, and all but one patient had significant reduction or eradication of varices. Three patients died of recurrent bleeding (17 percent) and one other required surgery. In the medically treated group, 3 patients died of bleeding (20 percent). Complications of sclerotherapy included mild bleeding (39 percent), chest pain (28 percent) and oesophageal ulcer (5.5 percent). OS reduces transfusion requirements in patients with recurrent variceal bleeding. (AU)

Pregnancy in chronic active hepatitis with cirrhosis

Pregnancy in chronic active hepatitis and cirrhosis is rare. There is an appreciable perinatal mortality and the effect of pregnancy on the underlying liver disease remains uncertain. Two patients with autoimmune chronic active hepatitis with cirrhosis who became pregnant during an active stage of their disease while on therapy are described. Both had an uneventful pregnancy with successful deliveries. One of the patients had two other prenancies but the pregnancy had to be terminated because of clinical deterioration. With close supervision patients with chronic active hepatitis and cirrhosis may have successful pregnancies. (AU)

Control of hypertension in a General Hospital Clinic, what are we achieving? - abstract

The records of 272 hypertensive patients attending the Spanish Town Hospital during the last four months of 1982 were assessed with respected to their last clinic visit. The ages ranged from 23 to 84 years, with a peak in the 6th decade. Sixty-eight per cent had been attending clinic for more than three years; 22 percent could be categorised as WHO Grade III hypertension and 19 percent as WHO Grade II. Based on either the initial blood pressure reading or a recent value while off treatment, 26 percent of patients had mild hypertension (diastolic B.P. 95-105 mm Hg Torr), 44 percent moderate (diastolic B.P. 105-110 mm Hg Torr) and 32 percent severe (diastolic B.P. 115-130 mm Hg Torr). Eight per cent had very severe hypertension (diastolic B.P. > 130 mm Hg Torr). All but 12 of the patients had been prescribed one or more of the seven antihypertensive drugs available in the Jamaica Government Medical Service. Twenty-seven per cent of subjects were on a one daily drug regimen, 41 percent on twice daily, 29 percent on thrice daily and four times daily on greater medication frequency. Thiry-two per cent were on a single drug only, 49 percent on two drugs and 19 percent on triple drug therapy. Thirty-one per cent of patients were on reserpine-containing compounds. 0nly 38 percent of patients had blood pressure levels below 150/100mm Hg Torr on the day of last clinic attendance. If the last three visits were analysed, the figure only rose to 42 percent. Control correlation best with frequency of medications - 5.7 percent of patients on once daily drugs were well controlled; 46 percent on reserpine containing compounds were well controlled and 63 percent with strokes were now well controlled. Reviewing the patients assessed as having poorly contolled hypertension, 32 percent were thought by the investigator either to be on an inappropriate drug or to have an inadequate drug dosage. Comments on patient compliance were only recorded in 24 percent of cases if the last three clinic attendances were reviewed, and drug side-effects in 15 percent. A sub-group of 100 poorly controlled pateints were interviewed to ascertain possible reasons for this. Seventy-eight had poor drug compliance, and 42 reported drug side-effects. Other reasons for non-compliance included failure of appreciation of the need for continued treatment, failure of appreciation of the risk of untreated hypertension, belief that the pressure was normal as long as they felt well, drug non-availability in hospital pharmacies and inability to afford the transportation costs of having the precription repeated monthly. Inappropriate drug therapy, inappropriate reduction of drug dosages, and being told by medical or paramedical personnel that they no longer needed treatment were also significant problems (AU)

Comparison of endoscopic brush cytology and biopsy in the evaluation of malignancies of the oesophagus and stomach - abstract

The value of brush cytology was compared to that of standard multiple biopsies in the assessment of lesions suspicious for malignancy at oesophagogastroscopy. Specimens from fifty-six patients were available for analysis: 36 from oesophageal sites and 22 from the stomach. A minimum of four slides were prepared for cytology in each case, and the results graded as negative for malignancy, suspicious, for malignancy or unsatisfactory. In twenty cases, both histology and cytology were positive for malignancy. In a further 11 cases histology was positive while cytology was graded as highly suspicious or suspicious. Three other patients with positive histology were regarded as having unsatisfactor cytological preparations. There were 2 false negative cytologies. On the other hand, there were 6 false negative biopsies with cytology positive or highly suspicious for malignancy, and two others with cytology positive and biopsies for malignancy. Eight patients had positive or highly suspicious cytology with unsatisfactory biopsies. In all cases with negative or unsatisfactory biopsies, malignancy was confirmed at operation or autopsy. One patient had a false positive (highly suspicious) biopsy and negative histology - absence of malignancy was confirmed at surgery. Three other patients had both cytology and biopsy negative; here two have had benign lesions confirmed at repeat endoscopy and one has been lost to follow-up (AU)

Sexual dysfunction among females on anti-hypertensive treatment - abstract

Sexual dysfunction is a common finding among males treated for essential hypertension, and is frequently cited as a cause of non-compliance with a therapeutic regimen. Reports of sexual dysfunction among treated women have been few, and there is little appreciation of how this problem affects the female patient. The present paper focusses on 112 pre-menopausal females, age 23 to 45 years, referred for evaluation of essential hypertension either as part of a pre-immigration physical examination or for management in a general medical out-patient clinic. Seventy-five women had been on anti-hypertensive treatment in the past or were on treatment at the time of evaluation. Previously treated women were kept on their old regime, and the others were put on a stepped-care protocol. After stabilisation of their blood pressure, all patients were questioned about sexual function while on treatment. Twenty-four women admitted to some degree of sexual dysfunction, loss of libido being the most significant problem. Twelve said they would enjoy sex after activity was initiated by their consorts, but thought their pleasure was considerably diminished by treatment. Four found that sex had become distasteful but continued to please their partners. Sixteen patients reported virtually complete loss of orgasm, and eight cited failure of lubrication as a significant problem. Eleven women admitted to more than one sexual problem. Only one admitted to pre-treatment sexual dysfunction. Four patients were thought to be depressed, by the medical attendant, and three of these responded to anti-depressant therapy plus a change of anti-hypertensive drugs. Of fourteen patients followed by the same physician for more than one year, eleven considered themselves restored to normal, or near normal, sexual function by a change of drug regimen but, in all cases, 2 or more different drugs had been tried before this was achieved. Only two women admitted to discontinuing drugs because of sexual difficulties. Sexual dysfunction in treated hypertensive females would therefore appear to be a significant problem. The present study may actually underestimate its extent, as there was a preponderance of middle-class women among those admitting to dysfunction: these females are presumably more educated and articulate and perhaps less embarrassed at discussing sexual matters (AU)

Effect of triamterene on leucocyte sodium and potassium levels in heart disease

Sodium and potassium levels in plasma and leucocytes and the sodium efflux rate constants of leucocytes were measured in patients with congenital heart disease not on treatment, patients with valvular heart disease being treated with digoxin and conventional diuretics showed low cellular potassium levels, low sodium levels. Patients given triamterene showed a rise in potassium levels in plasma and cells and in the sodium efflux rate constant (AU)