Fibrosarcoma of the vulva: case reports and discussion

Three cases of fibrosarcoma of the vulva are reported. In two, surgical resection resulted in remission over four years. In the third case, presenting with metastasis of the lung and liver, the patient died without surgery been carried out. The low mitotic index found in the first two cases seems to lead to a favourable prognosis, whereas the inferior vulvar localization found in the last case seems to be more dangerous because its diffusion into the paravaginal space

Proteinuria and the nephrotic syndrome in homozygous sickle cell anaemia

Thirteen patients with homozygous sickle cell anaemia (SCA) and clinical and laboratory evidence of renal glomerular disease were studied in an attempt to determine the pathogenesis of proteinuria and the nephrotic syndrome in this group of patients. Correlation was made between the clinical presentation and the renal histological changes in assigning the patients to various groups. Patients with active leg ulcers and acute presentations showed evidence of poststreptococcal glomerulonephritis and spontaneous resolution of the renal disease in the majority of cases. Other groups showed persistent proteinuria and/or progressive deterioration of renal function. Serological evidence of of streptococcal infection was present in all groups regardless of whether the renal histology showed a profilerative or membranoproliferative glomerulonephritis. It is concluded that streptococcal glomerulonephritis is an important cause of proteinuria and the nephrotic syndrome in SCA and that chronic leg ulceration may facilitate the acquisition of such disease (AU)

End-stage renal failure in sickle cell trait

Chronic renal failure in 3 patients with sickle cell trait is described. Renal biopsies in two patients showed membrano-proliterative glomerulonephritis. All 3 patients had regular haemodialysis and two had successful renal transplantation (AU)

Diffuse exudative proliferation in lupus nephritis

This study draws attention to a group of 6 patients who have diffuse proliferative lupus nephritis but in whom the renal histology is characterized by diffuse exudation and mesangial cell proliferation. This group of patients showed healing of the histological lesion in all cases although two of the patients died from non-renal causes. We conclude that this histological picture indicates a good prognosis in lupus nephritis.(AU)

Lupus nephritis in Jamaica

The renal biopsies of 48 patients with systemic lupus erythematosus were categorized into four histological groups - minimal change, focal proliferative, diffuse proliferative and membranous glomerulonephritis. Attempts at clinical correlation showed the broad grouping to have some prognostic value. However, the histological appearances within the various groups were quite diverse and this was especially so in the diffuse proliferative category where at least 6 sub-groups are described. Two sub-groups were of particular interest. The patients with a membranous glomerulonephropathy and superimposed endothelial cell proliferation accounted for 33 percent of our biopsies in the diffuse proliferative group and may be in part reponsible for the relatively good prognosis of this group. This histological picture raises the question of progression from membranous to diffuse proliferative lupus glomerulonephritis. The small sub-group of two patients with endothelial cell proliferation and polymorph infiltration is also of importance since it appears to have a good prognosis (AU)

Membranous glomerulonephropathy with crescents

Membranous glomerulonephropathy with crescents. A case is reported in which typical histological features of idiopathic membranous glomerulonephropathy co-existed with atypical glomeruli showing cellular epithelial crescents in addition to diffuse basement-membrane thickening. These features were seen in a renal biopsy specimen taken during rapidly progressive deterioration of renal function in a patient previously known to have mild ankle edema for four years

The spectrum of glomerular pathology in a West Indian population - abstract

Renal diseases account for up to 10 percent of deaths at University Hospital of the West Indies. (Hayes, Thorburn). In 1967 a grant from the Wellcome Trust enable us to begin a study of the morphology of kidney diseases as they presented in Jamaica and to relate the changes seen with the clinical syndromes, to provide a guide for clinical mangement and to ascertain, where possible, the aetiology of the various diseases. From 1967 to the present time 235 renal biopsies were performed by physicians using a Vim-Silverman needle usually under fluoroscopic control. Biopsy material was transferred directly from the needle into buffered glutaralde-hyde, minced into 1 mm cubes selected for electron microscopy and the rest was prepared for light microscopy in the standard way and stained with H&E, P.A.S. and memhenamine silver. Sections for electron microscopy were cut with an ultranmicrotome at 1 u and stained with alcian blue and silver. The pathological classification of the 235 renal biopsies were as follows: 16 percent were inadequate for proper assessment. 5 percent showed "minimal change" glomerulonephritis and were mainly from children with the nephrotic syndrome. 23 percent showed a diffuse proliferative glomerulonephritis and included three cases (1 percent) of the rapidly progressive type with extensive crescent formation. 10 percent showed a focal proliferative glomerulonephritis. 15 percent were from clinical proven cases of systemic lupus erythematosis. A further 2 percent had changes compatible with Systematic Lupus enthematosis although I.E. cells were negative. 2 percent (6) showed an epimembranous nephropathy but included 2 bio from proven cases of S.L.E. 6 percent showed a chronic glomerulonephritis. The remaining 18 percent constituted biopsies from patients with Leptospirosis (2 percent); Amyloidosis (1 percent) toxaemia of pregnancy, multiple myelomatosis, malignant lymphoma. hypertension, acute tubular necrosis interstitial nephritis and some cases of albuminuria associated with throtoxic patients treated with neomercazole (AU)

The prevalence of pyelonephritis among sicklers and non-sicklers in an autopsy population - abstract

It has been reported that there is a two-fold increase in the incidence of bacteriuria in pregnant Jamaican patients with the sickle cell trait. It has also been shown that the incidence of bacteriuria in sicklers as a whole is four times that of people who do not have S haemoglobin. Because of the correlation between bacteriuria and pyelonephritis, it could be inferred that the prevalence of pyelonephritis in sicklers might be higher than in non-siclklers. 6,750 consecutive autopsies done at the University Hopsital of the West Indies were reviewed. Of these 570 (approximately 8 percent) were stated as showing evidence of pyelonephritis or interstitial nephritis. Haemoglobin electrophoresis was attempted in a consecutive sereis of 645 autopsies. No results were available in 244 cases, but in 401 there were 33 patients with Hb AS. Six (18 percent) had pyelonephritis compared with 28 of 299 patients (9 percent) with Hb AA. One patient had Hb SS but had no pyelonephritis. The autopsy protocals of 31 patients with Hb SS were studied. Two of these (7 percent) had pyelonephritis. From the above it can be seen that there is no significant difference in the overall prevalence of pyelonephritis in the general population and the sicklers with Hb SS. There is, however, a difference in prevalence between the Hb AS group on the one hand, and the Hb AA and HB SS group on the other. This higher prevalence of pyelonephritis in the Hb SS group would be in keeping with the findings of others of an increased incidence of bacteriuria in Hb AS patients. The age relationship of pyelonephritis in our various grougps showed, in the Hb AA cases, a fairly even distribution of the majority between 40-80 years of age. However, 5 of the 6 cases in Hb AS group were between 60-80 years of age, whilst both Hb SS cases were between 30-40 years of age. The low prevalence of pyelonephritis in the SS patients may be attributed to the fact that about half died before the age of 10, thus there might not have been time for them to develop pyelonephritis (AU)