Gallstones in sickle cell disease: observations from the Jamaican Cohort study

The prevalence, incidence, risk factors, clinical associations, and morbidity of gallstones were studied in 311 patients with homozygous sickle cell disease and 167 patients with sickle cell-hemoglobin C disease in a cohort study from birth. Gallstones developed in 96 patients with homozygous sickle cell disease and 18 patients with sickle cell-hemoglobin C disease; specific symptoms necessitating cholecystectomy occurred in only 7 patients with homozygous sickle cell disease.(AU)

Renal length in sickle cell disease: observation from a cohort study

Renal length has been measured by ultrasound in 237 subjects with homozygous sickle cell (SS) disease, 147 with sickle cell-hemoglobin C (SC) disease, and in 78 age-matched controls with a normal hemoglobin (AA) genotype. As expected, renal length increased with age in all genotypes but mean length was significantly greater in SS disease compared with SC disease (mean difference 4.3 mm after adjustment for height) and significantly greater in both genotypes than in AA controls (SS/AA difference 9.2 mm, SC/AA difference 5.0 mm after adjustment for height). Examination of relationship between renal length and some hematological indices (hemoglobin, fetal hemoglobin, reticulocyte counts, alpha thalassemia status) in SS or SC disease showed only a significant negative correlation with hemoglobin and positive correlation with reticulocyte count in SS disease. Further analysis suggested that the stronger relationship was between renal length and high reticulocyte count. The mechanism of renal enlargement is unknown although glomerular hypertrophy and increase renal blood volume are likely contributors.(AU)

Biliary sludge in sickle cell disease

Biliary sludge was observed in the gallbladder in 17 of 429 patients in a cohort study of sickle cell disease. Discrete gallstones later developed in 12 patients, but no stones developed in five patients; one patient with biliary sludge had no change in his condition for 5 years. None of the patients with biliary sludge had any symptoms referable to the biliary tract, and cholecystectomy has not been performed. The Jamaican experience suggests that biliary sludge may be treated conservatively, similar to our approach to asymptomatic gallstone. (AU)

The chest radiograph in leptospirosis in Jamaica

A consecutive series of 44 patients with proven leptospirosis was studied to document the radiographic pulmonary abnormalities, assess their prevalence, correlate them with the clinical signs amd symptoms and determine their prognostic significance. Abnormalities were found in ten patients (23 percent), this prevalence being less than previously noted. The abnormalities shown were non-segmental opacification (consolidation-eight cases), basal linear opacities (collapse-five cases) and pleural effusions (four cases). The first radiographic demonstration of a large pleural effusion in leptospirosis is recorded. Non-jaundiced patients had a higher prevalence (43 percent) of these abnormalities than jaundiced (13 percent). No other correlation with clinical signs or symptoms was found. The presence of these abnormalities had no prognostic significance. It is concluded that the presence of radiographic pulmonary abnormality in in-patients with leptospirosis is common. These abnormalities are non-specific and can mimic other diseases leading to diagnostic difficulty. Such abnormalities may be extensive in the absence of clinical signs and symptoms. (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)

Hodgkin's disease and hypertrophic pulmonary osteoarthropathy

A case of mediastinal Hodgkin's disease associated with hypertropic pulmonary osteoarthropathy (HPOA) is described. The lung lesions almost completely cleared and the HPOA disappeared with adequate doses of radiation therapy (AU)

Some medical emergencies associated with swimming and diving

The risks, diagnosis and emergency management of drowning, ear injuries, burst lung and decompression sickness which may occur in swimming and diving are discussed. Emphasis is put on the importance of early diagnosis and of reaching recompression facilities as early as possible when appropriate (AU)

The metacarpal index in Jamaican children and adults

The metacarpal index was measured in radiographs of the hands of 615 male and 667 female Jamaicans aged over two years. The index increased with age from two years to adulthood, and was greater in females than in males, and greater in the left hand than the right hand. Means and standard derivations of the index for the left hand are presented as standards. An index of 9.6 for males and 10.1 for females over the age of 13 years is suggested as the upper limit of normal (three standards derivations above the mean). These standards are higher than those previously reported, and are probably applicable to other black populations outside Jamaica (AU)

Radiological evaluation of the cardiac apex in Jamaican children

The position of the clinical apex beat projected on chest radiographs was compared to different points on the cardiac outline which have been regarded as the radiological apex. Good correlation was found between the clinical apex and the most lateral point of the left cardiac border, but not with the cardiophrenic angle of the lower end of the long diameter of the heart. The mid-clavicular line cannot be used to define the upper limit of the normal sized heart on radiographs as in clinical practice, because in many of the subjects the heart extended outside the mid-clavicular line (AU)

The dangers in the use of intravascular contrast media during radiological investigations

The complications and dangers encountered when contrast media are injected into the vascular system are discussed. Suggestions are given in an effort to reduce the incidence of these complications, thereby making these radiological investigations safer for the patient (AU)

Acute rupture of the knee joint in rheumatoid arthritis

Two cases of acute rupture of the knee joint are described. The use of arthrography in diagnosis is demonstrated, and the aetiology and management briefly discussed (AU)