Metastatic neuroblastoma (sympathicoblastoma) of the mandible: report of a case

Malignant neoplasm of the jaws metastatic from primary sit elsewhere in the body do not constitute a numerically large group of lesions. A report of a metastatic neuroblastoma of the adrenal gland to the mandible of a one-year-old infant is described. The tumour was readily diagnosed based on detailed history, clinical examination, roentgenographic features and histologic features. The treatment was that of radiotherapy of the jaw lesion, followed by chemotherapy (AU)

An overview of current research on the biological effects of extracts from the unripe ackee (Blighia sapida L.) - abstract

It has been demonstrated that subacute intraperitoneal administration of high doses of the lipid fraction of the unripe ackee resulted in marked neutropaenia, pulmonary toxicity and changes in the blood chemistry in rats. This study has been carried out to further isolate the neutropaenic principle by testing both aqueous and lipid fractions and to see if this effect could be demonstrated in a different animal species. In mice, intraperitoneal administration of aqueous and lipid extracts of the ackee at a dose regimen of 300mg/kg thrice weekly for six weeks showed an initial rise, followed by a lowering of the neutrophil count, red blood cell count, haemoglobin, platelet count, serum albumin and alkaline phosphatase also decreased. It is concluded that in addition to it's hypoglycaemic principle, both aqueous and lipid extracts of unripe ackee, when adminstered separately, have neutropaenic activity. Further research involving characterization and testing is in progress. (AU)

Peripheral T cell lymphomas in Jamaica: relationship to HTLV-1 serostatus (abstract)

The clinico-pathologic features of 111 patients with non-Hodgkin's Lymphoma (NHL) exhibiting morphologic and immunophenotypic features of peripheral T-cell lymphoma (PTL) were analysed with respect to HTLV-I serostatus. 73 (65.8 percent) were HTLV-I seropositive (HTLV-I+) and 38 (34.2 percent) were HTLV-I seronegative (HTLV-I-). HTLV+ cases had a lower mean age (42.2 yrs) than HTLV- cases (50 yrs) and a male to female ratio of 1:1 while HTLV- cases showed a male preponderance (M:F 2:1). No significant differences in morphology were noted using the Japan Study Group classification. Both groups shared clinical features consistent with Adult T-cell leukemia/lymphoma but hypercalcemia was more likely to occur in the HTLV+ group [Hypercalcemia:- HTLV+ 50.7 percent, HTLV- 15.8 percent; Leukemia:- HTLV+ 39.7 percent, HTLV- 34.2 percent; Skin infiltration:- HTLV+ 38.3 percent, HTLV- 42.1 percent]. It would appear that some cases of HTLV- PTL could be included in the group classified as ATL given the occurrence of sentinel clinical features associated with ATL. Perhaps these will prove to be HTLV-I proviral DNA positive. Further studies to define this group are indicated. (AU)

Clinical aspects of blood transfusion in adults

The transfusion of blood or blood products may be life-saving or may reduce morbidity but also carries risks. Therefore, it should be prescribed only when it is clearly indicated, after a careful assessment of the benefits and risks for the patient. The pattern of blood usage in developing countries differs from that in developed countries. This reflects the better infrastructure (e.g. availability of safe water and adequate sanitation), public health services and more sophisticated health systems in developed countries, and the prevalence of some hereditary haematological disorders in developing countries. There are also differences in usage among developing countries, with the pattern in a small group similar to that of developed countries. In this paper we discuss the indications and the precedures for transfusion of blood and blood products, and outline the complications of haemotherapy and methods for avoiding or correcting them at the time of transfusion or afterwards (AU)

Beta-2-microglobin levels in HTLV-I infection - abstract

The human T-lymphotropic virus (HTLV-I) is endemic to the Caribbean and its importance as a possible cause of disease is increasing. Initial reports were of the association of HTLV-1 infection with adult T-cell lymphoma/leukaemia (ATL). Since then, tropical spastic paraparesis (TSP), infective dermatitis, polymyositis and more recently, crusted scabies have been reported to occur in individuals sero-positive for the virus. á2-microglobulin is a small peptide which forms the light chain of the HLA antigen that is present on the surface of nucleated cells. It has been shown to be an index to tumour burden in patients with lymphoma and to provide valuable information on the prognosis and response to therapy in patients infected with HIV. Here we reported on the serum á2-microglobulin levels in patients with lymphoma, TSP, infective dermatitis, children of HTLV-1-positive mothers and the relationship between HTLV-1 infection and á2-microglobulin levels. (AU)

Peripheral T-cell lymphomas in Jamaica an analysis of the relationship between morphology, clinical features and HTLV-I serostatus - abstract

We analysed the clinicopathologic features of 111 patients with T-cell lymphoma in Jamaica. The lymphomas were classified histologically according to the recommendations of Rappaport, the National Cancer Institute (NCI) Working Formulation and the Lymphoma Study Group in Japan. Phenotypice classification was based on the results of immunohistochemical studies utilising a panel of monclonal antibodies directed against T and B lymphocytes. Serum samples were screened for HTLV-I antibodies using the enzyme-linked immunosorbent assay and the results were confirmed by Western Blot. The presence of clinical features of Adult T-cell leukaemia/lymphoma (ATL) were assessed and compared between HTLV-I seropositive and HTLV-I seronegative groups. Seventy-three patients (65.8 percent) were HTLV-I seropositive and 38 were HTLV-I seronegative. Marked morphologic heterogeneity was noted within both groups. As expected, within the HTLV-I seropositive group many patients showed clinical features of ATL such as hypercalcaemia (37/73), leukaemia (29/73), bone marrow involvement (18/73), skin infiltration (28/73) and lytic bone lesions (4/73). Clinical features of ATL were also seen within the HTLV-I seronegative group. Fourteen patients (36.8 percent) showed two of the clinical features of ATL. Twelve (31.6 percent) showed one of the clinical features of ATL. It is possible that these patients may be HTLV-I seronegative and proviral DNA positive and should therefore be included in the ATL group. Further studies are necessary to confirm this. The remaining seronegative patients represent cases of T-cell lymphoma that are not associated with HTLV-I infection (AU)

Parasitic infections in young Jamaicans in different ecological zones of the island

Data are presented for the first country wide prospective study on gastrointestinal tract parasitic infections done in Jamaca. Samples from 2,947 young Jamaicans drawn from all ecological zones and from all parochial divisions of the island were analyzed. Pica was practised by 8.6 percent. Generally, prevalence of organisms was as follows: Trichiuris trichiura (12.3 percent). Ascaris lumbricoides (9.5 percent), hookworm (2.2 percent), Strongyloides stercoralis (0.35), Giardia lamblia (6.3 percent) and Entamoeba coli (7.7 percent). Several other species of protozoans were recorded. Prevalence of A. lumbricoides, T. trichiura and Necator americanus was significantly greater in upland than in lowland (both rual and urban), while the situation was reversed for G. lamblia-infections. Greatest variations were age-related. A.lumbricoides and T. trichiura reached peak prevalence of 15-19 years of age. Suggestions are made for a national and even regional antihelminthic program for the mass treatment of pre- and primary school age children. (AU)

Haemoglobin reference values in the Jamaican population - abstract

In a study of the iron nutritional status of the Jamaican population, the reference range for haemoglobin (Hb) was determined. Mean Hb levels in all age groups were markedly lower than internationally accepted values (Table). The cut-off points used to define anaemia were also determined and they were also markedly lower than the international values. Use of the local cut-off points resulted in a lower prevalence of anaemia than if international values were used and in the identification of one third of individuals with iron deficiency (determined by iron stores measurement) as being anaemic. Local reference ranges for haemoglobin should be developed, wherever possible, as this study clearly shows that the internationally accepted ranges are not universally applicable (AU)

The investigation and management of anaemia

Anaemia is a frequently encountered problem in clinical medicine found in diverse situations, and produced by varied mechanisms. Its investigation involves measurement of basic haematologic parameters initially, followed by a battery of more specialised tests, the use of which is guided by clinical judgement. Treatment of anaemia includes replacement of specifically deficient vitamins or minerals, chemotherapy for infectious diseases, hormonal imbalance or haematological and solid malignancies. Supportive measures including red cell transfusions, splenectomy and avoidance of certain drugs and occupations are also mainstays of management. Irrational shotgun therapy is not to be encouraged (AU)

Concurrent multicentric angiofollicular lymph node hyperplasia and peripheral T-cell lymphoma

Multicentric angiofollicular lymph node hyperplasia (MAFH) is a variant of Castleman's disease, localized angiofollicular lymph node hyperplasia. Unlike Castleman's disease, MAFH sometimes runs an aggressive clinical course culminating in death, mainly from infection and rarely from malignant lymphoma. The lymphoma may develop months or years after the onset of MAFH but may be present at the time of diagnosis. In this paper, we present a case of MAFH with co-existing peripheral T-cell lymphoma, in a 59 year-old man who died from disseminated disease. This adds another to the list of five such cases recorded in the literature since the recognition of MAFH (AU)

A case control study of adult T-cell leukaemia/lymphoma and human T-lymphotropic virus type I in Jamaica - abstract

Ninety-three patients with haematological malignancies were enrolled into the study between Janauary, 1984 and August, 1985. Of these, 23 fulfilled the clinicopathological criteria for the diagnosis of adult T-cell leukaemia/lymphoma (ATL). Eighteen of 23 ATL patients were HTLV-I seropositive, compared with 8 of 46 age- and sex-matched general medical controls, resulting in a claculated odds ratio (estimated relative risk) of 17:1. Other patients with non-Hodgkin's lymphoma had slightly higher seropositivity rates than the controls, but none of the other haematological malignancies were HTLV-I positive. No other risk factors for ATL were conclusively demonstrated. The recently noted association of HTLV-I with tropical spastic paraparesis (Jamaican neuropathy) was supported by a high level of HTLV-I antibodies among patients with certain neurological disorders (AU)