Vitamin-D deficiency rickets in Jamaican children

Vitamin-D deficiency is not as rare in Jamaica as previously believed. 9 children with vitamin-D deficiency rickets have been seen at the University Hospital of the West Indies during the past 5 years. All were over 3 years of age at time of presentation. Both dietary deficiency of vitamin-D and lack of exposure to sunlight seem to be important causes. Children living in rural Jamaica seem to be more susceptible to the disease than those living in a city, due perhaps to more prolonged breast feeding and lack of fortified milk feeds on weaning.(AU)

Patients requiring lower limb prostheses in Jamaica

One hundred and twenty-one consecutive cases of lower limb amputations seen at the Mona Rehabilitation Centre were reviewed. Diabetes accounted for the highest proportion of amputations. The ratio of above-knee to below-knee amputations was 1:1. Factors influencing the use of prostheses are discussed (AU)

Pyogenic osteomyelitis of the spine - an important differential diagnosis of tuberculosis of the spine - abstract

Pyogenic osteomyelitis of the spine can very easily be confused with tuberculosis of the spine. It is important that these two conditions be differentiated and this can be done by a careful assessment of the clinical and radiological features of each. 18 cases of pyogenic osteomyelitis of the spine seen at the University Hospital of the West Indies over the last 10 years are reviewed. The age incidence varied from 23 years to 65 years with an average age of 54 years. There were 14 males and 4 females. The lesions were distributed as follows - 13 lumbar, 4 thoracic and 1 cervical. There was an associated urinary tract pathology or surgical intervention on the urinary tract in 11 cases. There was only 1 case with diabetes and none with abnormal haemoglobin. There were no cases of typhoid osteomyelitis. There were no local abnormalities of the spine, apart from mild osteoarthritic changes and osteoporosis consistent with the age of the patient. Pyogenic osteomyelitis of the spine is a fairly rare condition. The chief aetiological factor in the development of this condition is urinary tract infection (AU)

Unusual cases of rickets - abstract

Four unusual cases of rickets presented at the Orthopaedic Clinic, University Hospital of the West Indies, with deformity of long bones. It was assumed at first that these were cases of vitamin D resistant rickets, rickets due to renal dysfunction, or malabsorption syndrome. Nutritional rickets was not considered since this occurs only when the child is not exposed to sunlight and there is a deficiency of fresh fruit and vegetables. This type of rickets occurs in infancy where the diet may be very limited. The children seen at the Orthopaedic Clinic ranged between the ages of 4 to 14 years, and presented with florid rickets. Blood chemistry revealed slightly low calcium, low phosphorus and elevated alkaline phosphatase. No abnormality was discovered in renal function tests and in the faecal excretion of fats. While the patients were being investigated, and without any treatment, the rickets healed, clinically and radiologically, on a normal ward diet. The rickets remained healed after the child returned to its previous environment. It appears therefore, that a type of nutritional rickets can occur in older children and in the presence of an abundance of sunlight. The aetiology of this nutritional rickets remains obscure (AU)

The early management of the bladder in young male paraplegics - abstract

The cause of urinary problems in the management of paraplegia is infection. This infection is iatrogenic and is introduced via a catheter. For some years the Spinal Unit at the University Hospital of the West Indies has been treating paraplegics without the use of a catheter. The patient is put on a regime of manual decompression as soon as he is admitted to the Unit. A history and physical examination are done to exclude the possibility of urethral obstruction or damage. The chief objection to this method of treatment is that the intravescical pressure generated by manual decompression is enough to cause ureteric reflux and finally impaired renal function. The renal function of paraplegics of over three years who had been treated by manual decompression of the bladder was investigated. The blood urea of all patients treated by manual decompression was normal, whereas of those treated by prolonged catheterised had urinary infection but of those treated by manual decompression only one patient had urinary infection. The patients treated by manual decompression all had normal I.V.P.'s and in no case was ureteric reflux demonstrated on micturating cystograms. Manual decompression results in sterile urine and does not damage the urinay tract, urinary problems are caused by infection introduced by a catheter(AU)

XYY Sex chromosomes in a Jamaican with orthopaedic abnormalities

A male Jamaican patient is described with a bilateral deformities of the knee, mental retardation, and hypogonadism. He was found to have retarded bone age, varicose ulceration, a height of 227 cm (89 1/2in.) and a XYY sex chromosome constitution. The relation of these features to the presence of 2 Y chromosomes is discussed, and a paternal age effect is suggested in the origin of the condition. (Summary)