Uterine sarcoma in Jamaican women

A review of 55 cases of uterine sarcoma recorded in the Jamaican Cancer Registry for the period 1958-1973 showed an annual incidence of 0.45 cases per 100,000 population, representing a 2.9 percent tumour incidence among all female genital cancers. Clinicopathological studies of 34 cases revealed that these tumours in the Negro population showed little difference from reports elsewhere in their epidemiological, clinical, pathological and prognostic aspects. The only difference was in cases of leiomyosarcoma in the young premenopausal women with rapidly growing uterine masses together with a high mitotic count, who had a poorer prognosis compared with older patients with this tumour. Surgical treatment of patients with leiomyosarcoma was hysterectomy and bilateral salpingo-oophorectomy, while mesenchymal sarcomas were treated with extended hysterectomy. Both groups of patients had postoperative radiotherapy. The 5-year survival was 30 percent in the former and 10 percent in the latter group. Postoperative radiotherapy in both groups failed to improve this poor prognosis but adjunctive immunotherapy may have a role in future treatment schedules (AU)

Cryptococcosis in the West Indies

Crptococcosis with meningitis is reported in seven patients, six from Jamaica and one from Belize. All seven had headache, six had fever and five had confusion/coma. Despite biochemical findings of meningitis in the cerebrospinal fluid of five patients, Cryptococcosis was diagnosed antemortem in only three. Two patients treated with oral flucytosine survived. Awareness that Cryptococcosis occurs in the West Indies may assist in early diagnosis which is crucial to successful treatment (AU)

Tumours of the testis in Jamaica

Malignant tumours of the testis are reported to be rare in negroes. All cases reported in the records of the University Hospital of the West Indies and the Jamaica Cancer Registry over the period June 1958 to December 1976 were studied. There were 26 cases, giving a world standardised incidence of 0.40 per 100,000 per year. This incidence is higher than that seen in African negroes but lower than that of negroes in North America. The peak age incidence is a decade later that commonly seen in high incidence countries (AU).

Neonatal death at the University Hospital of the West Indies

Neonatal deaths at U.H.W.I. from 1974 - 77 were analyzed. The neonatal mortality rate over the 4 -year period was 16.87 per 1,000 live-births. Very low birth-weight babies (<1,500 gms.) accounted for 8.89 deaths per 1,000 live-births or 52.6 percent of all deaths even though their numbers were small (152;1.68 percent of total births). The increasing risk of death with decreasing gestational age is quantitated as is the contribution of first day deaths. Autopsy was performed in 78 percent of all neonatal deaths. Agreement between the clinician and the pathologist as to the principal cause of death was achieved in 80 percent of babies dying. The majority of deaths were due to one of 5 conditions: congenital malformations, infection, respiratory distress syndrome, intrapartum hypoxia in very immature babies. There was a tendency for infection to be under-diagnosed. The prevention of death due to infection is clearly the first priority in Jamaica. (AU)

Early deaths in Jamaican children with sickle cell disease

In Jamaican children with homozygous sickle cell (SS) disease diagnosed at birth two-year survival was 87 percent, compared with 95 percent in children with sickle cell-haemoglobin C (SC) disease, and 99 percent in normal controls. Death among those with SS disease occurred most often between the ages of 6 and 12 months. Principal causes were acute splenic sequestration and pneumococcal infection. Neonatal diagnosis of haemoglobinopathies must be followed by close observation if mortality is to be reduced by early diagnosis and treatment of these complications. (AU)

A method for comparing endotracheal cuffs: a controlled study of tracheal trauma in dogs

Damage to the trachea produced in dogs by large and small residual volume cuffs during 6 h of IPPV was compared using a specifically designed endotracheal tube. The cuffs under evaluation were adjusted to exert similar average pressures on the tracheal walls, so that many of the variables believed responsible for tracheal injury were controlled. The tube compliance of the cuff was measured with tube inside and outside the trachea of the anesthetized dogs. The maximum estimated pressure transmitted to the tracheal wall, derived from these compliance curves, was found to equal the peak airway pressure in the presence of a small air leak past each cuff. At various tracheal wall pressures there were only minor differences in tracheal damage between the large and small residual volume cuffs tested (AU).

Sinus Histiocytosis with massive lymphadenopathy: clinico-pathological features of four cases

Four cases of sinus histiocytosis fulfilling the clinico-pathological requirements laid down by Rosai and Dorfman are reported. This benign disease is characterized by massive lymphadenopathy especially in the cervical region and pathologically by enlargement of lymph node sinuses by phagocytic histiocytes. The disease is self-limiting, regressing over a variable period of time from months to years. These four cases and the six reported by Rosai and Dorfman are, to our knowledge, the total number of cases reported in the West Indies to date (AU)

Apudomas of the pancreas

Apudomas of the pancreas form an interesting group because of their varied presentation which is frequently related to clinical syndromes caused by production of one or more hormones. We have had experience with the management of the two commonest syndromes associated with endocrine tumours. The ability of these tumours to produce more than one hormone and to be part of the multiple endocrine adenopathy should encourage more intensive biochemical and histochemical examination of patients presenting with these syndromes (AU)

Perinatal mortality in the University Hospital of the West Indies

Perinatal mortality (including late neonatal deaths) in the University Hospital of the West Indies, from July, 1973 to June, 1975, is compared with that reported a decade previously. No improvement in the perinatal mortality rate is observed. (35.1/1,000 in 1963-65; 35.8/1,000 in 1973-75) (AU)

Alterations in secretion and fine structure of histamine stimulated stomach mucosa following administration of oestrogens

The observation that benign peptic ulceration is less common in females during the reproductive period and the suggestion that oestrogens have an inhibiting effect upon the activity of carbonic anhydrase led us to investigate volumetric and ionic (H+, K+, NA+, C1-.) changes in gastric secretion and also the fine structural changes in gastric oxyntic cells following administration of oestrogens. Fifteen male dogs after 24 hour fasting were anaesthetised with ketalamine hydrochloride and then subjected to a constant i.v. infusion of histamine phosphate, (approx. 14ug/Kg/hour). Twelve dogs underwent truncal vagotomy and ligation at the distal oesophagus. Gastric secretions were collected at 20 minute intervals via a tube introduced into the most dependant part of the stomach through a duodenotomy. The pylorus was ligated around the tube. Approximately 3 hours later, when three consecutive specimens were similar in volume, 4mgm/Kg Premarin (Eguine conjugated oestrogens) was injected i.v. into ten dogs. Further specimens were collected for three hours. Gastric mucosal biopsies were taken from three histamine stimulated dogs before and after injection of Premarin 4mgm/Kg. and were prepared for electron microscopy. The mean hourly volumes of secretion diminished at one, two and three hours after Premarin (ANOVA F 4.5; d.f. 3:33; p< 0.05) with an inhibition of 65.3 percent of the mean pre-Premarin value observed at the third hour. There was a significant rise in the mean pH one hour after Premarin in P<0.05, however, after this there was no significant variation. There was an apparent rise in the mean sodium concentration in the first two hours with a statistically significant rise at three hours after Premarin p<0.05. No significant changes were observed in the mean Potassium or Chloride concentration. The comparison of fine structure of 40 oxyntic cells, 20 before and 20 after Premarin injection, showed an apparent reduction in numbers of canaliculi, with lengthening of the canalicular microvilli. Except for the absence of demonstrable effects on Potassium and on cytoplasmic micro-vesicles these results are comparable with reported findings after inhibition of carbonic anhydrase by acetazolamide (AU)

Jejunal biopsy studies in malnutrition

A modified paediatric Watson biopsy capsule was used to take peroral biopsies of the jejunal mucosa from 10 malnourished Jamaican children. Biopsies were taken after admission and again prior to discharge several months later. These biopsies have been compared by dissecting microscopic and histological studies, and by estimation of the mucosal disaccharidase activities. On admission the mucosa showed varying degrees of abnormality and frequently had a decrease of all the disaccharidase activity levels. When a gross abnormality was present there was a definite improvement in the mucosal appearance after clinical recovery: these changes were associated with a rise in the disaccharidase levels(AU)