Carcinoma of the penis in Jamaica - abstract

Two hundred and seventy-three histologically proven cases of carcinoma of the penis were treated in the University Hospital from 1953 to 1966 i.e. approximately 20 cases per year. The geographical distribution of the cases are shown - 75 per cent were in the 40 to 69 age group. The youngest patient was 21 years of age and the oldest 85 years. The majority of patients were in the lowest socioeconomic group. 75 per cent were unskilled workers, a large number of whom were illiterate. Only 3 per cent were white collar workers. With one exception, all patients were negro or of negro extraction. One hundred and forty-four patients (53 percent) were married or lived in common-law union. One hundred and seventeen patients (43 percent) were unmarried; 41 of these confessed to fathering 1 to 10 children each. Information as to previous clinical venereal infection was obtained from 126 patients. One hundred confessed to buboes or urethral discharged; 26 denied previous infection but in 20 of these, VDRL, LGVCFT, or GCFT was positive in 29 per cent of 188 patients tested; LGVCFT was positive in a titre of 1:40 or higher in 25 per cent of 208 patients, VDRL or Wassermann reaction was positive in 59 per cent of 231 patients. In 56 patients there was serological evidence of more than one previous infection. It is possible that yaws may have accounted for a number of the positive VDRL reactions but a clear history of previous yaws infection obtained in only one patient. Fifteen patients gave a history of penile ulceration which healed with streptomycin therapy, and in 20 other patients, the depigmented scars associated with healed granuloma inguinale were present. Thirty-three patients were referred from the venereal disease clinic. All patients were uncircumcised in infancy or childhood. In 73 patients (27 percent) there was a tight phimosis necessitating a dorsal slit in order to reveal the lesion and to obtain a biopsy. Only 28 patients were circumcised - all but four in the 3 years preceding attendance, and in the majority for symptoms which were related to the lesion. A history of trauma was obtained from 8 patients. Nine patients were diabetic and 3 suffered from chronic generalised dermatological disease. Only 108 patients (40 per cent) was it possible to determine the site of origin. In the others the lesion was too expensive. Sixteen patients were referred with a proven histological diagnosis. Eleven patients were referred with recurrent tumour which had been treated by amputation or radiotherapy 3 months to 2 years previously. Eighteen patients suffered from severe concomittant disease - cardiac failure, hepatic failure, hemiplegia, spastic paraplegia, uraemia - which delayed treatment. Carcinoma of the penis is a public health problem. The high incidence in Jamaica may be related to several factors - low standard of education in the group affected, poor personal hygiene in an uncircumcised population, promiscuity associated with a high venereal infection rate, or granuloma inguinale. Treatment and prognosis are not discussed but the latter is affected by the delay in seeking treatment and intercurrent disease in the age group at risk (AU)

Anomalous lacrimal ductule: case report and review

A case of anomalous lacrimal ductule is reported. Review of the literature shows that only 5 cases have been reported previously. (Summary)

Tumors of salivary gland origin

In 64 patients, an unusually high percentage of salivary gland tumors occurred in accessory salivary tissue, ectopic sites, and in accessory salivary tissue, ectopic sites, and sublingual gland, corroborating experiences in other tropical hospitals. The incidence of all tumors was: parotid 57.8 per cent, submaxillary 17.2 per cent, sublingual 4.7 per cent, and accessory and ectopic sites 20.1 per cent. The ratio of benign to malignant tumors was 3 to 1. Two benign tumors occurred in unusual sites which were the external auditory canal and the lacrimal gland. Recurrences, particularly in the parotid gland, resulted from inadequate excision. Facial nerve palsy occurred postoperatively in 7.8 percent of the patients. One patient died as a result of surgery. Mucoepidermoid carcinoma was the commonest type of malignant tumor found, involving particularly the parotid and subligual glands. The sentinel node of the parotid gland was found to be a useful guide, and frozen sections of tumor were not altogether reliable. The method of treatment of malignant tumors of salivary gland origin should be based largely on the histology, and more radical operations should be adopted (AU)

Ano rectal carcinoma in Jamaica

Sixty-eight patients attended the University College Hospital from September 1952 to December 1960 for treatment for carcinoma of the rectum. For the early lesion, which formed the minority of our patients, the prognosis is good. Eleven patients were treated for carcinoma of the anus and anal canal. The prognosis of this lesion is poor. The association of ano rectal carcinoma and lymphogranuloma venereum is discussed (AU)

Rectal lymphogranuloma venereum in Jamaica

One hundred patients with rectal lymphogranuloma venereum were treated at the University College Hospital, Jamaica. Patients were all of the lowest socio-economic group. Ninety per cent of patients were females. The generally accepted theory of spread of infection by lymphatics from vagina to rectum is refuted and the possibility of contiguous spread is suggested. The disease is chronic, progressing from proctocolitis to ano-rectal stricture. Secondary infection probably contributes to stricture formation. Early treatment of proctocolitis by broad spectrum antibiotics prevents stricture formation. Major operation is required only for the extensive stricture. In all cases restoration of sphincter function should be the aim. This has been achieved by an intra sphincteric proctectomy in many cases (AU)

Rectal lymphogranuloma venereum in Jamaica

Lymphogranuloma venereum is a major public health problem in Jamaica. With improvement in the standard of living, better housing, better general education, a healthier sex education, and a more active programme of venereal disease control, the incidence of rectal lymphogranuloma should diminish. The early diagnosis and treatment of the proctocolitis by drugs is effective and should reduce the incidence of stricture. Major operations should be reserved for cases in which the more conservative methods of treatment are unlikely to succeed or have failed. At present, in Jamaica, operation necessitating a permanent colostomy should be considered more carefully than in this country. Unfortunately our attempts to eradicate the disease by operation and leave the patient with a functioning anus have been attended with only very limited success. Some of the failures may be attributed to insufficent experience with these operations, but involvement of the sphincter in the dense fibrotic process is probably responsible for the majority. In these fibrotic sphincters functional control is impossible. In a small number of cases intra-sphincter proctectomy in one stage by the method described by Dimitrui and Gregoresco (1933) has given promising results where the sphincter is free. The disease appears to be self-limiting. There has been no evidence of reactivation after removal of the affected gut even though this is rarely a complete en bloc excision or indeed even after colostomy only. Our follow up has been short. I have deliberately avoided the term "cure" because rarely has the compliment fixation reaction been reversed to negative. The significance of a persistently positive serological reaction in the absence of clinical evidence of disease is yet to be assessed. We have come a long way since John Hunter described the bubo 175 years ago and Frei placed the study of the disease on a firm aetiological basis 140 years later. In the past 35 years our knowledge of the lympho-granuloma venereum virus has increased, but the problem of treatment of rectal stricture, the most disabling complication of the disease, awaits solution. Morte (1933) stated: "The study of the stricture of the rectum is as fascinating as the treatment is discouraging. " In 1960 we can say: "Treatment of rectal stricture is often disappointing, but the results are encouraging" (Summary)

Rectal lymphogranuloma venereum in Jamaica

A brief history of lymphogranuloma with special reference to rectal involvement is given. Experience in Jamaica in the treatment of 144 cases of rectal lymphogranuloma is reported. In cases of proctocolitis, patients can be relieved of rectal stricture only by its removal but symptoms may be relieved by more conservative treatment. Excision operations should be reserved for the severe cases. The prognosis of proctectomy with preservation of sphincter function should be guarded. The abdomino-end-anal operation of Dimitriu and Gregoresco has given promising results. (Summary)

Carcinoma of the penis in Jamaica

Data on 61 cases of carcinoma of the penis treated at the College Hospital, University of the West Indies, are reported, covering a period of six years. The various etiologic factors are discussed, with particular reference to granuloma inguinale. The literature is reviewed, and the observations here set forth are compared with those obtained by other investigators. (AU)

Barium studies in intestinal lymphogranuloma venereum

The radiological appearance of the colon and rectum in lymphogranuloma venereum in a study of 144 cases treated in the University College Hospital of the West Indies, are described and illustrated. The extent of the disease can be assessed only by a barium enema examination. The colon is always affected in the stage of proctocolitis and often in the structure stage. (AU)

Calcinosis

Two cases of "idiopathic" calcinosis in young boys are reported. One patient received no treatment; in the other, rapid recurrence, followed excision. Both patients are well two and a half years and one and a half years, respectively, after the diagnosis was made and show no evidence of collagen disease. The literature is reviewed (Summary)

Multicystic disease of the kidney in the newborn: report of two cases

Two cases of multicystic disease of the kidney are reported. This disease should be regarded as an entity not to be confused with polycystic disease of the kidney. The aetiological agent is discussed and the literature reviewed (Summary)

Ureterocele: a case report

A case of a large ureterocele in an adult male is reported. The ureterocele was complicated by hydronephrosis and hydroureter and multiple ureteral calculi, and the patient presented with gross hematuria and retention of urine due to calculus obstruction of the urethra. Treatment was by ureterocelectomy and removal of the calculi. The literature was reviewed. (Summary)

Carcinoma of penis

Data on 61 patients with carcinoma of the penis treated at the University College Hospital of the West Indies over a period of six years is presented. The aetiology is discussed. The policy in treatment has been conservative and is probably justified by the results obtained. (AU)

Halothane and carbohydrate metabolism

Halothane does not block the sympathetic response to surgery indicated by a rise in blood sugar and a fall in liver glycogen in Jamaican patients (Summary)

Duplication of stomach and duodenum: A case report

Duplication of the entire stomach and first part of the duodenum in a ten week old male infant is reported. This is the fourth case of complete duplication of the stomach and the first in which the duodenum is also duplicated. The history on gastro-intestinal duplication is reviewed and the aetiology of the anomaly discussed. (AU)

Observations of cancer of the oesophagus in Jamaica

Data on 73 cases of carcinoma of the oesophagus treated at The University College Hospital of the West Indies are presented. Patients with cancer of the oesophagus attended hospital at a very advanced stage of the disease. The prognosis is poor. In no case was a curative resection possible. With the exception of two cases, all patients with carcinoma of the oesophagus died within 7 months. (AU)

Observations on cancer of the stomach in Jamaica

Data on 182 cases of carcinoma and five cases of rare malignant tumours of the stomach treated at the University College Hospital of the West Indies in the six-year period (September 1952 to August 1958) are presented. In Jamaica patients with cancer of the stomach attended hospital at a very advanced stage of the disease. The prognosis is bad. Better results will be obtained with better cancer education of the public, the realization that cancer of the stomach occurs commonly in the young patient and above all by provision of facilities for early radiological investigation easily available to poor Jamaican patients in all parts of the island. (AU)

Primary plasmocytoma of the stomach

The seventh case of solitary plasmocytoma of the stomach is reported. It is suggested that in this case and possibly in others the tumor arose as a rare type of malignant change in a chronic peptic ulcer. The literature on extramedullary plasmocytoma of the gastro-intestinal tract is reviewed (Summary)