Massive ascites secondary to severe endometriosis

Massive ascites is an unusual association with endometriosis. This case report is of such a condition in an Afro-Jamaican woman. The diagnosis was made at laparotomy and conservative treatment was adopted allowing for retention of reproductive function. Postoperative therapy was Goserelin, a Gonadotropin Releasing Hormone (GnRH) agonist, for six months. This relieved all of her symptoms. However, long term follow-up is needed, as recurrence is possible.(AU)

Obturation obstruction in a cocaine smuggler

A case of obstruction is reported in a 34 year-old narcotics smuggler. The typical diagnostic features of the presence of narcotics-filled packets in the gastrointestinal tract on the abdominal radiographs are highlighted. This should serve to alert physicians to this unusual aspect of the narcotics problem which, according to press reports, is gaining in significance in the Caribbean today (AU)

Dysphagia lusoria: a rare cause of dysphagia

Dysphagia lusoria is a rare cause of dysphagia. It is usually due to a combination of an aberrant right subclavian artery and either a close origination of the common carotid trunk. A middle-aged man presenting with dysphagia due to an aberrant right subclavian artery and closely originating carotid arteries less than 1 cm apart is presented. Barium swallow demonstrated the characteristic oblique external compression effect on the upper posterior oesophagus. Oesphagoscopy confirmed an extrinsic defect in the upper oesophagus which was pulsatile. Dysphagia lusoria is a clinical entity that is not well recognized and should be considered in patients with upper oesphageal dysphagia in whom the cause is not obvious (AU)

Idiopathic pulmonary artery dilation

Idiopathic pulmonary artery dilation is a rare but definite clinical entity. It must be distinguished from dilatation secondary to congenital and acquired cardiac or pulmonary disorders causing pulmonary hypertension. A middle-aged woman with idiopathic pulmonary artery dilation who was initally referred for evaluation of a mediastinal tumor is described. Idiopathic pulmonary artery dilatation should be considered in any patient with a prominent pulmonary arch and normal peripheral lung vascularity (AU)

Ultrasonography in the diagnosis and management of biliary ascariasis

Biliary ascariasis has traditionally been a poorly recognised clinical entity. Because of unsatisfactory diagnostic tests, most diagnoses are made accidentally by surgeons at laparotomies for evaluation of right upper quadrant pain, often misdiagnosed as cholecystitis. Consequently this has been regarded as a "Surgical" condition. Diagnostic ultrasonography offers a reliable method for evaluating the biliary tree. At ultrasonography, Ascaris lumbricoides can be indentified in the biliary tree and medical management pursued. Follow-up ultrasound studies enable the process of resolution to be monitored and possible complications to be identified. This is the first report on the use of diagnostic ultrasonography in the diagnosis and management of biliary ascariasis in the English-speaking Caribbean, and illustrates the characteristic diagnostic features of the condition. A new sign of biliary ascariasis, 'the can of sausages sign', is also described (AU)

Polysplenia and reversed rotation of the midgut

A 3-week-old female infant with polysplenia syndrome and partial situs inversus with reversed rotation of the intestinal tract who presented with subacute bowel obstruction at the University Hospital of the West Indies is reported. The absence of associated cardiovascular anomalies is notable. A modified Ladd's procedure was successful in relieving the obstruction. The clinical and diagnostic features of polysplenia syndrome are discussed. When complex cardiovascular anomalies, which usually account for the high mortality rate, are absent, normal growth and development can be expected. (AU)

Long-term plasma exchange in patients with systemic lupus erythematosus and diffuse proliferative glomerulonephritis

Thirty-nine patients with systemic lupus erythematosus and diffuse proliferative nephritis were enrolled in a randomized controlled trial of long term plasma exchange therapy. All patients received conventional therapy, and in addition, 20 were exchanged with albumin or plasma. The 20 exchange patients did not show a better preservation in renal function. However, a significant difference in renal function was observed in the 16 exchange patients who were replaced with albumin. This finding was underscored by two-way analysis of variance and convariance, which revealed that background variables favored a better prognosis for the nonexchanged patients.(AU)

Conn's syndrome: case report and a review of the syndrome of primary aldosteronism (SOPA)

This report describes the investigation and treatment of a 30-year-old woman with Conn's Syndrome caused by an aldosterone-producing right adrenocortical adenoma associated with the classic triad of hypertension, hypokalaemia, and metabolic alkalosis. Removal of the tumour resulted in the reversal of these abnormalities. To the best of our knowledge, this is the first case of Conn's Syndrome in the West Indies. It is hoped that, with the presently improved diagnostic facilities in the region, this report will stimulate interest in finding other cases of this rare but important and treatable cause of secondary hypertension (AU)

Foley catheter hysterosalpingography - abstract

Radiologist and obstetricians normally perform hysterosalpinography by introducing a metallic cannula into the cervical canal, where contrast medium is injected in X-rays made for evaluation of uterine and tubal disease. This procedure is painful and cervical tears and perforation are no infrequent complications. Leakage of contrast medium from the cervix frequently results in inadequate studies. Dissatisfaction with this technique has resulted in the advocacy of uteroscopic and laparoscopic approaches. A simple Foley Catheter Technique is described. An 8F Foley Catheter is introduced into the cervix and balloon inflated. This occludes the cervix and permits good uterine and tubal filling by injected contrast medium. This procedure requires no special instrumentation and can be performed on a simple X-ray table. Ninety (90) consecutive studies performed between May, 1983 and December, 1983 are presented. Eighty-eight (88) were successfully performed and all were of good diagnostic quality. Patient tolerance was excellent with minimal pain. The Foley Catheter Technique is therefore highly recommended for safe and reliable hysterosalpingography (AU)

Heart size and chest shape in homozygous sickle cell disease

The hoop-shaped chest is a well-recognised but unexplained feature of the abnormal anthropometry of SS disease, developing in children by the age of 4-6 years. The hypothesis that cardiomegaly may influence abnormal chest growth has been tested by examining the relationship between cardiac volume and the antero-posterior/lateral chest diameter ratio in children aged 6-8 years. The finding of a significant positive correlation supports this hypothesis (AU)

Ultrasonography in jaundice - abstract

The evaluation of the patient with suspected obstructive jaundice has traditionally been perplexing. Liver biopsy and percutaneous transhepatic cholangiography are invasive and not widely available. Many patients have therefore not benefited from pre-operative diagnosis. Between August 1981 and December 31st, 1982, 127 such patients were referred for ultrasound examination. In 74 cases biliary obstruction was demonstrated and in 73 the level of the obstruction was identified. The cause of obstruction was identified in 64 of these. Inoperability was predicted in 19. In 16 cases, a non-obstructing lesion associated with jaundice was seen and in 37 the sonogram was normal. The need for liver biopsy was reduced to 37 cases and for percutaneous cholangiogram to 10. In this service hepatobiliary ultrasonography now stands as the investigation of choice in suspected obstuctive jaundice (AU)

Pulmonary alveolar proteinosis in Jamaica

The clinical radiological and pathological features of two cases of pulmonary alveolar proteinosis are described. A further three cases have been diagnosed in Jamaica since 1960 and a summary of the clinical, radiological and pathological features of these cases is also presented. (AU)

Bronchogenic carcinoma - a radiologic tragedy - abstract

This study attempted to establish the radiological appearances of bronchogenic carcinoma in Jamaica and to compare these with some North American patterns. The presenting chest X-Rays in sixty patients with histologically proven bronchogenic carcinoma were reviewed and the radiological patterns identified. Eighteen (18) cases presented as solitary parenchymal masses with 8 associated with hilar adenopathy and 3 with pleural effusions. Five cases had a peripheral mass with adjacent rib destruction - 4 being apical tumours, the histological types being anaplastic, squamous cell and undifferentiated carcinoma. Eighteen (18) cases presented as a hilar mass and 8 were associated with atelectasis. Four cases presented with complete lobar or lung collapse, 7 as massive pleural effusions, 3 as multiple pulmonary nodules, 2 as cavitating masses and one each as diffuse infiltrate, atelectasis with hilar calcification and superior mediastinal widening. Thirty-two (32) had measurable masses. Of the nineteen measurable peripheral masses, there were less than 3 cm in diameter and sixteen measured between 5 and 12 cm in diameter. Comparable results from the Lehey Clinic Series revealed twenty-five peripheral masses measuring less than 3 cms in diameter and sixteen greater than 3 cms in diameter. The large size of the mass lesions and evidence of spread of malignancy at the time of presentation indicate a high incidence of advanced disease when compared with the Lehey Clinic pattern and the results of the Philadelphia Pulmonary Neoplasm Research Project. A public education campaign and more regular use of routine chest X-Rays in the age group at risk are necessary for prevention and early diagnosis (AU)

Rupture of the right hemi-diaphragm secondary to blunt trauma

Injuries to the right hemidiaphragm secondary to blunt trauma are unusual. Three new cases are reported, demonstrating the need for a high index of suspicion in patients with blunt abdomino-thoracic trauma. Routine examination ofthe hemidiaphragm should also be performed when laparotomy is pursued in such patients. Radiological investigations are often helpful in evaluating the patient with the "high right hemidiaphragm" and here the possibility of a traumatic right hemidiaphragmatic hernia should always be considered, even if no history of recent trauma is given (AU)

Percutaneous transhepatic cholangiography

The experience with percutaneous transhepatic cholangiography at the University Hospital of the West Indies has been reviewed. The success rate has increased with improved technique, and the results of this series compare favorably with other workers. The introduction of the flexible 23-gauge Chiba needle has further reduced our morbidity with the procedure and, although the interval between study and laparotomy within 24 hours of PTC is still recommended. The selection and preparation of patients remain of paramount importance especially to document and to correct coagulation defects and biliary infection prior to embarking on the investigation (AU)