Ectopia cordis: ethical dilemma in a developing country

Etopia cordis is a rare congenital abnormality affecting the heart which is present either totally or partially outside the thorax. Because of associated cardiac defects, survival beyond birth is uncommon. One such case in whom death occurred on the 23rd post-operative day from heart failure is described and the management and ethical considerations discussed. This is the first case which has survived beyond birth in Jamaica.

Access to urethral stump in radical prostatectomy - abstract

Prostatic carcinoma is the commonest cancer in the male and is now being more frequently diagnosed at an earlier and potentially curable state. The operation of radical prostatectomy offers the best chance of a cure and is therefore being more often used in preference to radiotherapy. Vesicourethral anastomosis is probably the most technically difficult part of this procedure as the urethral stump may not be clearly visible nor accessible. When poorly performed, anastomosis may contribute to the increased morbidity associated with extravasation, incontinence and stricture formation, and may negate the success of a nerve sparing operation. Visibility of and access to the urethral sphincteric stump may be greatly increased by placing a Foley catheter in the urethra with its tip protruding into the pelvis through the stump. With 8 ml of water inflating the balloon which lies under the perineal membrane, traction upwards elevates this stricture along with the urethral stump into the pelvis. The technique has been successfully used in eight (8) patients over the past year with no untoward complications (AU)

The POEMS syndrome

The POEMS syndrome is an unusual disorder manifesting primary as peripheral sensorimotor neuropathy in association with a monoclonal gammopathy. The importance of its recognition is that significant clinical improvement may result from localization and treatment of the underlying plasma cell tumour. AU)

A rapid epidemiological assessment of rubeola resurgence in a suburban Jamaican community - abstract

An assessment of a measles (rubeola) resurgence in a small surburban Jamaican community was undertaken so as to relate the development and progress of the outbreak to salient epidemiological variables. Measles immunization histories were assessed for cases presenting at the local health centre and individual and community morbididty determined. Data were collected with the help of a community health aide from community visits to all basic and primary schools and two backyard nurseries and from clinical records during the ninth week of the outbreak, and on an on-going basis from clinic records. The outbreak of measles (75 cases) in this community lasted 22 weeks with an epidemic curve showing a picture of a propagated epidemic. Clustering was noted in the more deprived areas, with fifty percent of the individuals presenting belonging to addresses with more than one case. The male-female ratio was 1.3:1 with a modal age group of 1 to 5 years (45.8 percent of cases), infants (<1 yr.) accounting for 8.3 percent. Of the cases presenting, 44.2 percent were previously vaccinated against measles (61.5 percent in the general clinic population). Fever, cough and skin rash were the most common recorded presenting clinical features (78, 74 and 88 percent, respectively). One death was reported in a four-year-old child. The incidence of the disease for the first three months in the schools visited ranged from 1 in 9 children in a medium-sized basic school to 1 in 27 in a large primary school. Follow-up with respect to immunization following school entry was found to be generally poor. The formal approach to epidemic investigation may connote large scale efforts consuming much time and manpower. This report, however, shows what can be done in a short time with limited resources. The rapid epidemiological assessment was facilitated by the positive response of the community to the investigation and the ability of the team, including the community health aide, to make prompt yet effective contact with community members. Despite the expected defects in the data collected, a working picture of the epidemiological status of the community was quickly constructed. This picture provides the basis for primary health care intervention such as the targeting of high-risk groups in more deprived areas, reviewing and evaluating the immunization process, and monitoring and enforcing adequate standards of school health (AU)

Intestinal malabsorption in strongyloides stercorales infestation

Intestinal malabsorption resulting from this disease is rare, and only two recent reports are available. The clinical picture of severe malnutrition with a bizarre duodenal lesion and larvae of the S.S. in the duodenal mucosa is presented in three cases. The existence of malabsorption as deduced by the low serum albumin levels and other biochemical tests, as well as the depressed absorption of iron salts and D. Xylose are presented. The iron absorption, compared with that in hookworm infestation, is presented. Histological evidence of flattening of the duodenal mucosa and mucosal invasion by the rhabditiform larvae are also presented. Treatment with dithiazine iodide may produce recovery (AU)

Sarcoidosis in Jamaica

Sarcoidosis is reportedly rare in the West Indies, yet among West Indian immigrants in London the disease has been frequently found. Over the past 10 years there have been 22 histologically proven cases of sarcoidosis at the University Hospital of the West Indies, Jamaica and a review of these cases was presented. The clinical picture differed in several aspects from that reported in other communities. Extrapulmonary lesions were common, and spontaneous remissions were exceedingly rare (AU)

Hereditary hypochromic anaemia with iron loading

An unusual case was reported in which a 24 year old Jamaican male was found to have a constitutional defect of iron metabolism involving the utilization of pyridoxine in hemoglobin formation. It was found that pharmacological doses of Vit B6 allowed a greater rate of haemoglobin formation without altering the fundamental defect which caused iron accummulation in the body (AU)

Acute viral encephalitis in Jamaica

Experience with twenty-five cases of acute encephalitis believed to be of viral origin has been analyzed. There is serological evidence that three of these cases were due to St. Louis virus. An unknown virus was isolated from the serum of one patient. In most of the cases, onset of illness was sudden. Fever, headache and mental change were the main symptoms. There was a mortality rate of 16 percent. It is significant that in about 35 percent of the cases, there was some residual defect after illness. (Summary)

Unusual aspects of reticuloses

Tumours of the reticulo-endothelial system appear to be common at the U.C.W.I. Hospital and within the last three years some 80 cases have been seen. 7 of these cases with very unusual initial manifestations were presented in the hope that awareness of the bizarre symptomatology of the reticuloses may lead to earlier diagnosis (AU)

Typhoid fever

The clinical course of 121 cases of typhoid fever seen and treated at the University College Hospital of the West Indies is reviewed. Details of management are discussed and the question of relapse examined. (AU)

Hereditary persistence of foetal haemoglobin: A family study suggesting allelism of the F gene to the S and C haemoglobin genes

A large family is described in which the inheritance of a gene responsible for high levels of foetal haemoglobin (the F gene) and its interaction with the gene for haemoglobin-S is followed through three generations. Four cases of SF combination are reported. An example of the the CF combination is described. Evidence is produced that the F gene is situated at the same locus as the S and C genes and the gene for classical thalassaemia, and that it is therefore an allele of them. As an altenative explanation it is suggested that the high levels of foetal haemoglobin may not result from direct gene action but may be due to a failure of inheritance of normal haemoglobin following a deletion at the A-S-C locus (or a mutation lethal for beta-chain production), with a consequent revival of the dormant mechanism of foetal haemoglobin synthesis. Sickle-cell anaemia and the SF combination are phenotypically indistinguishable, and the difficulties in explaining the very marked clinical difference between them are discussed (Summary)

A review of typhoid infection in Jamaica - abstract

During the period 1952-1959 there were two major epidemics of typhoid in Jamaica and 121 documented cases of typhoid infection were treated at the University College Hospital. Diagnosis was made mainly on culture of the organism and less reliance was placed on Widal agglutinations as T.A.B. inoculations are frequently given prophylactically in Jamaica. This disease was found to be mainly one of the young age groups. Although most cases responded to treatment, there was a relapse rate of 8 percent. Despite chloramphenicol, deaths continue to occur and a mortality rate of 5.8 percent found. The cost of treatment runs to thousands of pounds - a wasteful effort against a preventable disease (AU)

Clinical aspects of encephalitis in Jamaica (abstract only)

Random sampling of a small segment of the Jamaican population has shown so far, that on the results of immunological studies two of the Group B neurotropic viruses, viz. St. Louis and Dengue, exist in the island. It is not surprising, therefore, that clinical cases of acute viral encephalitis occur all over the island. This short paper is a brief analysis of 25 cases of acute viral encephalitis treated at the University College Hospital of the West Indies. The diagnosis was confirmed at autopsy in 3 cases, although the causative agent was not identified. The difficulties in isolating the virus or proving its presence by anti-body reactions are discussed. Attention is drawn to the main symptoms and physical signs, special mention being made of the frequency of gastrointestinal complaints in the presenting symptomatology. Four cases died. Residual sequelae were common in children. Early diagnosis and treatment with corticosteroids may lead to a more favourable outcome (AU)

The natural history of syphilitic heart disease as seen in a hospital population (abstract only)

An attempt has been made to give an assessment of aortic incompetence in a hospital population and to show the expectation of life once cardiac failure has developed. Seventy one cases have been analysed and 32 are dead, 15 of these from cardiac failure due directly to the incompetent aortic valve. All but 3 of the cases dying perished within 2 years of the onset of symptoms mainly in the fifth decade of life; in these 3 survival up to 5 years was possible. Of the cases still living the average follow-up period is 28 months, but again survival up to 4 years and beyond is possible even after the onset of cardiac failure (AU)

Datura poisoning: A case report

A case of accidental poisoning with Datura strammonium in an adult male is reported. (AU)

Some aspects of diabetes in Jamaica

The clinical features of diabetes in Jamaica, as exemplified by 103 cases admitted to the University College Hospital of the West Indies during 1955, are described. Diabetes is an important cause of hospital admissions in Jamaica. Three main types of diabetes, and a subgroup of the type II cases, are discussed. (AU)