The outcome of Trabeculectomy with Mitomycin C at the Queen Elizabeth Hospital, Barbados

AIM: To evaluate the efficacy of trabeculectomy with mitomycin-c in a predominantly black population. METHOD: The records of 43 eyes with 34 patients (males 15, females 19; age range 22-87 years), who underwent trabeculectomies with mitomycin-c for uncontrolled glaucoma at the Queen Elizabeth Hospital were reviewed. Forty-three eyes (rt eyes 22, Lt eyes 21, unilateral 25, bilateral 9, combined procedure 4) had trabeculectomies. All surgeries were performed by six surgeons between July 1995 and October 1998. The concentration of mitomycin-c varied from 0.2 to 0.5 mg/ml and was applied over 2 to 5 minutes. RESULTS: We evaluated treatment outcome based on the following categories of surgical results for patients with a pre-operative IOP>21mmHg. 1. The operation was considered successful when the IOP was <21mmHg without any anti-glaucoma medications. 2. The operation was a failure when the IOP was raised >21mmHg and required anti-glaucoma medications to control the IOP. The mean preoperative IOP was 26mmHg and the mean postoperative IOP was reduced to 14mmHG. There was failure in 19 eyes where the IOP was raised over >21mmHg and required anti-glaucoma medications or control. Twenty-four eyes were still functional at 18 months with IOPs less than 21mmHg without any anti-glaucoma medications. Visual acuity (VA) in the functional 24 eyes: the VA remained the same in 9 patients and the VA progressively deteriorated in the remaining 15 patients in spite of reduced IOP after mitomycin trabeculectomies. CONCLUSION: The most common cause of failure after trabeculectomy is scarring at the filtration site due to fibrosis or more appropriately normal healing by fibrosis - mitomycin simply delayed the normal healing. Eyes with pseudopakia are at higher risk for failure. Most of the studies in the past were done in the predominantly white population with a short follow-up period. In contrast, all the patients in this study were of African origin and had at least 18 months follow-up, with mean follow-up of 39 months. To our knowledge, this is one of the longest follow-up studies in a predominantly Black population and is the first in the Caribbean. (AU)

Human T-lymphotropic virus type I DNA in spinal cord of tropical spastic paraparesis with concomitant human T-lymphotropic virus type I negative Hodgkin's disease

We studied a 58 year old black women from Barbados who simultaneously developed myelopathy and lymphoma with human T-lymphotropic virus type I (HTLV-I) antibodies in serum and cerebrospinal fluid and died 3 years after onset. Neuropathological examination showed typical tropical spastic paraparesis (TSP). The polymerase chain reaction (PCR) demonstrated defective proviral genome retaining the HTLV-I pX and env regions in thoracic spinal cord, the level most severely affected. Defective HTLV-I in the nervous system retaining the pX region may be relevant to pathogenesis because circulating CD8+ cytotoxic lymphocytes specific for HTLV-I pX occur in HTLV-I myelopathy. This patient's lymph node biopsy specimen was consistent with Hodgkin's disease (HD), nodular sclerosis subtype, of B-cell origin. The PCR in the paraffin-embedded lymph node involved by HD failed to amplify HTLV-I proviral sequences. Complete HTLV-I proviral amplification was obtained in paraffin-embedded lymph node form positive controls (adults T-cells leukemia). To our knowledge the association of TSP and HD has not been reported previously. Despite claims the HD may be associated with HTLV-I, we demonstrated absence of HTLV-I infected T-cell in the lymphoid infiltrate of HD in this case, positive HTLV-I serology notwithstanding.(AU)

Aspergillosis in a patient with acute lymphoblastic leukaemia

A case is described of a three year old boy with acute lymphoblastic leukaemia (ALL) who presented initially with aspergillosis of the nasophgillosis of the nasopharynx. Fungal infection with Aspergillus species is not uncommon in immunosuppressed children, but this case is noteworthy in that the disease presented at the onset of therapy rather than during the phase of treatment with maximum immunosuppression following chemotherapy. This type of infection is usually associated with the treatment of acute non-lymphoblastic leukaemais (AMS) rather than ALL, and prolonged periods of neutropenia which results from aggressive treatment. This patient responded rapidly to treatment with amphotericin B, coincident with resolution of his neutropenia as the underlying disease was treated, eventually eradicating the fungus (AU)

Childhood malignancies in Barbados (1985-1989): incidence and survival - abstract

The lack of frequency data on childhood malignancies in the Caribbean prompted this 5-year (1985-1989) retrospective study of childhood malignancy in Barbados. Case finding of malignancies in children <15-years-old attending the Queen Elizabeth Hospital, Barbados was undertaken by reviewing medical and other related records for the period of study. Health statistics for the island were obtained from the Statistics Department of the Ministry of Health. There were 44 cases of childhood malignancy of whom 15 died, representing about 0.3 to 1 per cent of all cancer deaths annually. The average annual incidence of childhood cancer for the 5-year-period was 143.5 per million children. Fourteen types of childhood malignancies were found, and the commonest types were brain tumours (27 per cent) and haematological cancers (27 per cent) (AU)