Crohn's disease in Jamaica

Twenty patients with Crohn's disease seen in Jamaica over the past 20 years are reviewed. There were 14 women and 6 men. The mean age at presentation was 37 years, and symptoms were present for a mean of 12 months. Fourteen patients presented with lower abdominal pain, and diarrhoea was present in 11. Lower gastrointestinal bleeding was the presenting feature in 2. The distribution of disease was ileal in 6, and 8 had primary colonic involvement. Three patients had ileocolitis and one perianal disease. One had involvement of the entire small intestine and ascending colon and another had skip lesions involving several areas of the small intestine. Surgical resection was performed in 5 patients. Of the 15 patients treated medically, 6 have remained well while 8 had recurrent episodes of relapse. Crohn's disease is an uncommon disorder in Jamaica, but should be considered in patients presenting with imflammatory bowel disease (AU)

Does Crohn's disease occur in Jamaica? - abstract

Crohn's disease is one of the most frequently encountered chronic digestive diseases in areas of North America and Europe with a marked rise in incidence over the past 20 years. However, there is considerable geographical variation in incidence of this disease. It seems to be relatively rare in Jamaica and the Caribbean. Twenty patients with Crohn's disease seen over the past 20 years at the University Hospital, Kingston, Jamaica are reported. There were 14 female and 6 males. The mean age at presentation was 37 years (range 8-67), and symptoms were present for a mean of 12 months (range 1 day-4 yrs). Fourteen patients presented with lower abdominal pain and diarrhoea was present in eleven. Lower gastrointestinal bleeding was the presenting feature in two. Ten patients had weight loss. Four patients had a tender mass in the right lower quadrant of the abdomen and in a fifth patient the mass was located in the lower umbilical region. Thirteen of the twenty patients were anaemic (Hb less than 11 grams/dl) and 9 had hypoalbuminaemia at presentation. The primary distribution of disease was ileal in six and eight had colonic involvement. Three patients had ileocolitis and one perianal disease. One patient had invlovement of the entire small intestine and ascending colon and another had skip lesions involving several areas of the small intestine. Surgical resection was performed in five patients. Three other patients required laparotomy for intestinal obstruction and another for drainage of an inflammatory mass. Three patients developed entero-enteric fistulas and two entero-cutaneous fistulas. Of the 15 patients medically treated 6 have remained well while 8 have had recurrent episodes of relapse. Except for two deaths, the other patients have remained well. Crohn's disease, although uncommon, has been seen in Jamaica for the past 20 years and should be considered in West Indian patients presenting with inflammatory bowel disease. In contrast to other series, most of our patients were black with a female preponderance, but the clinical features, anatomic involvement and course appear similar to those reported elsewhere (AU)

Does the "Dumping Syndrome" occur in Jamaicans?

In order to test whether the "dumping" syndrome occurs in Jamaicans after gastric surgery, we studied 48 patients and six normal volunteers. Subjective assessment and objective testing were carried out after a standard hypertonic (provocative) glucose meal. Serial packed cell volume estimations were carried out, and the percentage fall in plasma volume (an indication of dumping) was calculated from a standard equation. Forty percent of patients reported symptoms of dumping after gastric surgery, and even more (55 percent) had a significant fall in plasma volume. The syndrome occured most commonly after gastric resection or a drainage procedure, and was least prevalent after the operation of highly selective vagotomy (AU)

Experience with sham-feeding as a postoperative test of vagotomy

Sixty-six sham-feeding tests by the chew-and-spit method, using a standard weight hamburger as a test meal, have been carried out on 38 patients and 12 controls. Twenty-four of these were done before surgery for chronic duodenal ulcer, twenty-three, 3 months after surgery and seven, 1 year after the operation. In addition, a group of twelve persons without gastrointestinal symptoms was tested in a similar fashion as controls. One hundred and three insulin tests were carried out at various intervals after surgery on fifty duodenal ulcer patients. After surgery, a similar reduction in basal acid output (BAO) was observed in both sham-fed and insulin groups. Two of the twelve controls and two patients out of the twenty-four in the pre-op. group had a minimal response to the sham-feeding and another two actually had inhibition of secretion, suggesting that perhaps hamburger was not the best meal of choice for these individuals. Apart from the problems of using a meal of choice for each individual in sham-feeding, this test gives the same information as the insulin test and, because it is safer and more physiological, we would recommend its use (AU)

Prediction of post-operative wound infection by a simple score system

Eight hundred and twenty-nine surgical patients were monitored for post-operative wound infections as well as associated risk factors from January to December 1980 at the University Hospital of the West Indies. Age over 50 years,diabetes mellitus, duration of pre-operative hospitalisation, urgency of operation, duration of operation > 2 hours and the degree of wound contamination were found to be association with increased risk of infection. A simple score system has devised to predict the overall risk of infection. A simple score system has been devised to predict the overall risk of wound infection in general surgical patients (AU)

Oesophageal varices - abstract

The treatment of bleeding oesophageal varices remains a frustrating exercise for physicians and surgeons. At the University Hospital of the West Indies, during the period January 1971 to December 1982, 53 patients were admitted with bleeding oesophageal varices. The diagnosis was confirmed by barium meal, oesophagoscopy, surgery or at post-mortem. Thirty-nine of these were males. Their ages ranged from 11 to 81 years. Forty-two belonged to the 40 to 60-year age group. Initially, all patients were treated with blood transfusion, intravenous pitressin and the Sengstaken Blakemore tube. In 10 patients the bleeding stopped and they were discharged home. Of the remaining 43 patients, 29 died without surgery. Sixteen patients died within 3 days of admission, 7 patients were not fit for surgery and 6 refused operation. Fourteen patients underwent surgery. Eleven had an emergency surgical procedure to control bleeding and only 3 of these survived. Three patients had elective operations following conservative control of bleeding and all of them survived. The overall mortality form bleeding oesophageal varices of 70 percent reflects our difficulty in controlling bleeding adequately in the initial stages as a prelude to elective portal decompression in these patients. The reason for this are: (a) difficulty in monitoring the patients with Sengstaken-Blakemore tube on the general wards, and the frequent non-availability of the tube, (b) difficulty in obtaining adequate amounts of blood, and (c) lack of early surgical intervention in cases where bleeding is not controlled by conservative means. It is our belief that patients with acute variceal haemorrhage should be manged in an Intensive Care Unit. In this setting we are more likely to be able to control bleeding and to prepare the patient for elective surgery. We also need to develop a more aggresive approach to those patients whose bleeding is not promptly controlled and to advise surgical intervention before the general conditions of the patient deteriorates to a point where he is no longer fit for surgery (AU)

Highly selective vagotomy and digital dilatation for stenosing duodenal ulcer - abstract

Twenty-eight patients (24 males and 4 females) with pyloroduodenal obstruction due to chronic duodenal ulcer had highly selective vagotomy (HSV) alone (6/28) or HSV and digital dilatation (DD) of stenosis (22/28), 1 to 4 years previously. Their ages ranged from 19 to 61 years, with a mean of 42 years. There was no post-operative death. One patient had perforation of the duodenum during dilatation. The only patient with Hb SS disease, a male aged 49, died from haemorrhage and perforation of recurrent ulcer 1 year after surgery. Two other males had easily controllable recurrent duodenal ulcers, but no stenosis. Another male died of unrelated cause after two symptom-free years. Six males were re-operated on for symptoms of gastric stasis. Only 3 of these were found to have complete fibrous stenosis for which gastro-enterostomy was done. The other three had adequate pyloroduodenal lumen. Patients with inflammatory stenosis do well after HSV and DD, but this combined procedure should be avoided in fibrous tissue stenosis (AU)

Experience with "Sham" feeding as a test of gastric secretion - abstract

Sham feeding by the "chew and spit" method using a hamburger has been carried out on 17 patients with chronic duodenal ulcer before surgery, 20 three months after surgery and 6 one year after surgery. A group of 11 unmatched controls was tested in a similar fashion. The insulin test was carried out at various intervals after surgery on 50 duodenal ulcer patients. The surgery significantly reduced basal acid output (BAO). However, after surgery (as was to be expected), BAO was similar in both the sham fed and insulin groups. Two out of 11 controls and two out of the 17 pre-op group had a minimal response to the sham feeding and another 2 actually had inhibition of secretion, suggesting that perhaps hamburger was not the best choice of meal for these individuals. Apart from the problems of choice of meal in sham feeding, because this test gives the same information as the insulin test and because it is safer and more physiological, we would recommend its use (AU)