Helicobacter pylori infection in the Caribbean: update in management

Helicobacter pylori infection of the stomach is one of the commonest chronic infections world wide and in the Caribbean, over 50 of the population are affected. H pylori is probably transmitted from person to person by oro-fecal and oro-oral means. H pylori is directly associated wirh peptic ulcer disease, chronic antral gastritis, gastric carcinoma and B-cell lymphoma of the stomach. In patients with peptic ulcer and H pylori infection, eradication of infection with antibiotics significantly decreases recurrence of ulcers. All patients with H pylori related disease should be tested and treated if positive. The treatment of H pylori infection has evolved over the years but at present triple therapy which includes two antibiotics is recomended.(AU)

Hepatic cirrhosis in Jamaica

The aetiology, biochemistry, clinical features and complications of histologically confirmed hepatic cirrhosis in 45 patients (26 females, 19 males) seen at the University Hospital of the West Indies, Jamaica, between 1984 and 1994 was presented. The age range was 1 to 72 years (mean 48 years). Abdominal swelling and weight loss were the commonest symptoms, occurring in 51 percent and 47 percent of patients, respectively. Jaundice was a presenting feature in 44 percent. Hepatomegaly was present in 71 percent of patients and splenomegaly in 33 percent. The aetiological factors were: alchol (36 percent), bush tea (18 percent), chronic active hepatitis (11 percent), drugs (7 percent), and haemochromatosis (2 percent). Hepatitis B surface antigen was detected in 2 of 20 patients tested. 24 percent of the patients also had diabetes mellitus, 29 percent were anaemic, 29 percent were thrombocytopenic, 4 percent were leukopenic, and the prothrombin time was prolonged in 22 percent. The albumin/globulin ratio was reversed in 71 percent of the patients. The alkaline phosphatase was elevated in 56 percent, the aspartate aminotransferase was increased in 58 percent and the gamma glutamyl transpeptidase in 56 percent. 56 percent of the patients had macronodular cirrhosis; the liver showed a micronodular pattern in 18 percent; 7 percent had biliary cirrhosis; 7 percent chronic active hepatitis with cirrhosis; and 13 percent showed a mixed macro-micronodular pattern. Ascites and fluid overloaded developed in 44 percent of the patients. Hepatic encephalopathy occurred in 18 percent and upper gastrointestinal bleeding in 18 percent.(AU)

Hepatic cirrhosis in Jamaica

The aetiology, biochemistry, clinical features and complications of histologically confirmed hepatic cirrhosis in 45 patients (26 females, 19 males) seen at the University Hospital of the West Indies, Jamaica, between 1984 and 1994 was presented. The age range was 1 to 72 years (mean 48 years). Abdominal swelling and weight loss were the commonest symptoms, occurring in 51 percent and 47 percent of patients, respectively. Jaundice was a presenting feature in 44 percent. Hepatomegaly was present in 71 percent of patients and splenomegaly in 33 percent. The aetiological factors were: alchol (36 percent), bush tea (18 percent), chronic active hepatitis (11 percent), drugs (7 percent), and haemochromatosis (2 percent). Hepatitis B surface antigen was detected in 2 of 20 patients tested. 24 percent of the patients also had diabetes mellitus, 29 percent were anaemic, 29 percent were thrombocytopenic, 4 percent were leukopenic, and the prothrombin time was prolonged in 22 percent. The albumin/globulin ratio was reversed in 71 percent of the patients. The alkaline phosphatase was elevated in 56 percent, the aspartate aminotransferase was increased in 58 percent and the gamma glutamyl transpeptidase in 56 percent. 56 percent of the patients had macronodular cirrhosis; the liver showed a micronodular pattern in 18 percent; 7 percent had biliary cirrhosis; 7 percent chronic active hepatitis with cirrhosis; and 13 percent showed a mixed macro-micronodular pattern. Ascites and fluid overloaded developed in 44 percent of the patients. Hepatic encephalopathy occurred in 18 percent and upper gastrointestinal bleeding in 18 percent.

Ramsay hunt syndrome complicated by contralateral cerebral infarction

Varicella-zoster virus has been associated with a variety of neurological manifestations. We describe a patient with the Ramsay Hunt Syndrome who developed a contralateral cerebral infarction. (AU)

Eosinophilic meningitis: is angiostrongylus cantonensis endemic in Jamaica?

A case of eosinophilic meningitis presenting as pseudotumour cerebri is described, along with evidence to suggest that the causative agent was angiostrongylus cantonensis. (AU)

Pulmonary nocardiosis in a patient with human immunnodeficiency virus disease

Nocardiosis is an uncommon disease which occurs most often in patients with impaired cellular immunity, yet is rarely reported in patients with human immunodeficiency virus disease. We present the first case of Nocardiosis seen at the University Hospital of the West Indies, occurring in a well-controlled diabetic with human immunodeficiency virus disease. (AU)

Pulmonary nocardiosis in a patient with human immunnodeficiency virus disease

Nocardiosis is an uncommon disease which occurs most often in patients with impaired cellular immunity, yet is rarely reported in patients with human immunodeficiency virus disease. We present the first case of Nocardiosis seen at the University Hospital of the West Indies, occurring in a well-controlled diabetic with human immunodeficiency virus disease.

Eosinophilic meningitis: is angiostrongylus cantonensis endemic in Jamaica?

A case of eosinophilic meningitis presenting as pseudotumour cerebri is described, along with evidence to suggest that the causative agent was angiostrongylus cantonensis.

Multicentric angiofollicular lymph node hyperplasia in ulcerative colitis: a case report

Multicentric angiofollicular lymph node hyperplasia (MAFH) is a rare disorder which has been associated with various disease entities. This is the first report of its association with ulcerative colitis. details of lymph node histology and views on pathogenesis (AU)

Multicentric angiofollicular lymph node hyperplasia in ulcerative colitis: a case report

Multicentric angiofollicular lymph node hyperplasia (MAFH) is a rare disorder which has been associated with various disease entities. This is the first report of its association with ulcerative colitis. details of lymph node histology and views on pathogenesis

Asymptomatic cardiac involvement in systemic lupus erythematosus

Cardiologic and laboratory parameters were studied in 21 patients with systemic lupus erythematosus (SLE) with cadiopulmonary symptoms (CPS), 20 SLE patients without CPS and 45 age-and sex- matched healthy controls. The most frequent cardiac abnormalities in patients with CPS included pericardial effusion (24 percent), ventricular enlargement (20 percent), mitral regurgitation (19 percent) and tricuspid regurgitation (14 percent). No structural abnormalities were observed in SLE patients without CPS. Mean calculated and derived echocardiacgraphic values in both groups of SLE patients differed significantly from those observed in normal controls (p< 0.004). Patients with CPS had significantly lower mean values of ejection fraction (p< 0.05) and fractional shortening (p< 0.03). However, the frequencies of functional abnormalities in patients with CPS did not differ significantly from those observed in patients without CPS. There were no remarkable laboratory findings in SLE patients with CPS compared to those without. The finding that some SLE patients may have functional cardiac abnormalities in the absence of CPS is an important one. It raises the question as to whether asymptomatic cardiac involvement in SLE is a separate entity or whether it heralds symptomatic cardiopulmonary involvement (AU)

Asymptomatic cardiac involvement in systemic lupus erythematosus

Cardiologic and laboratory parameters were studied in 21 patients with systemic lupus erythematosus (SLE) with cadiopulmonary symptoms (CPS), 20 SLE patients without CPS and 45 age-and sex- matched healthy controls. The most frequent cardiac abnormalities in patients with CPS included pericardial effusion (24 per cent), ventricular enlargement (20 per cent), mitral regurgitation (19 per cent) and tricuspid regurgitation (14 per cent). No structural abnormalities were observed in SLE patients without CPS. Mean calculated and derived echocardiacgraphic values in both groups of SLE patients differed significantly from those observed in normal controls (p< 0.004). Patients with CPS had significantly lower mean values of ejection fraction (p< 0.05) and fractional shortening (p< 0.03). However, the frequencies of functional abnormalities in patients with CPS did not differ significantly from those observed in patients without CPS. There were no remarkable laboratory findings in SLE patients with CPS compared to those without. The finding that some SLE patients may have functional cardiac abnormalities in the absence of CPS is an important one. It raises the question as to whether asymptomatic cardiac involvement in SLE is a separate entity or whether it heralds symptomatic cardiopulmonary involvement

Thyrotoxic periodic paralysis in a Jamaican male patient

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)

Polyarteritis nodosa in Jamaicans

This report describes the main features of the 5 cases of polyarteritis nodosa seen at the University Hospital of the West Indies over a 10-year period. The disease manifestations are protein and only 2 of the 5 patients were diagnosed antemortem, indicating the need to increase physician awareness, especially since response to therapy has improved significantly in recent years. (AU)

Significant liver disease in sickle cell anaemia and related haemoglobinopathies

A prospective study is in progress in order to determine the relationship of viral hepatitis to significant liver disease in patients with sickle cell anaemia and related haemoglobinopathies. Two groups of patients are being studied: 1. Patients selected at random from the Sickle Cell Clinic of the University Hospital of the West Indies - These have blood taken for liver function tests and detection of Australia antigen. 2. Patients with sickle cell disease and cholestatic jaundice - these are hospitalized, and have liver biopsies in addition to routine investigations. In none of 106 patients selected from the Sickle cell Clinic, did liver function test reveal evidence of significant liver disease, but three patients had Antigenaemia. The livers of these patients were biopsied, and the appearances on light microscopy were compatible with a form of viral hepatitis in two of them. Two patients have been seen with cholestatic jaundice. One had initial biopsy evidence of acute viral hepatitis without antigenaemia, but showed the picture of chronic persistent hepatitis on follow-up biopsy. The other had initial biopsy evidence of chronic aggressive hepatitis with antigenamia, a repeat biopsy five months later was inadequate for proper histological assessment. These preliminary results suggest that viral hepatitis may play an important role in significant liver disease occasionally seen in patients with sickle cell anaemia and related haemoglobinopathies (AU)

Hyperinfection with strongyloides stercoralis - abstract

A combination of the history, clinical signs and the presence of a high proportion of the invasive filariform larvae, is sufficiently diagnostic of Strongyloides stercoralis hyperinfection. Early recognition and effective treatment of this condition can avoid the occasionally associated mortality. The clinical, laboratory, radiological and histological aspects of 23 patients with the condition seen at the University Hospital of the West Indies and not previously reported, are presented. The course of hyperinfection was found to be predominantly a chronic one, in which the prevalence of abdominal pain, weight-loss, vomiting and hypoalbuminaemia was greater than 90 percent but was acute and fulminating in 3 cases. The overall mortality was 35 percent. Radiological abnormalities were maximal in the duodenum and jejunum, mucosal cedema, dilation and reverse peristalsis being commonest. Treatment with conventional drugs did not uniformly cause complete eradication of the organism, but in vitro, in vivo and clinical comparisons indicate that a new drug Levamisole is significantly more effective than Thaibendozole against strongyloides stercoralis (AU)