Male breast cancer - an analysis of four cases and review of the literature

We report the cliniopathological features and outcome of four cases of carcinoma of the male breast diagnosed at the University Hospital of the West Indies between 1988 and 1998. Male breast cancer is most commonly seen in men over age sixty years, and it exhibits the same prognosis, stage for stage, as the disease in females. However, some researchers report overall poorer survival in men, and explain this on the basis of advanced disease at presentation. Other researchers maintain that the majority of breast cancers in males present at early stages, and exhibits survival similar to that in females. The published literature concerning this uncommon malignancy is reviewed, and the data are compared with the features of our cases.(Au)

Outcome of stage I carcinoma of the breast at the University Hospital of the West Indies (1982-1988)

The five-year survival data for 62 patients with Stage I breast cancer treated at the University Hospital of the West Indies (UHWI) between 1982 and 1988 were evaluated to determine which factors were affecting outcome. The overall survival rates (66.7 per cent ) were below those quoted from large multicentre studies from North America, Western Europe and Australia. The most significant survival differences emerged in the subset of postmenopausal patients with cliniclly staged disease who fared worse than those with pathologically staged disease. These data suggest that clinical staging is inadequate for the management of Stage I breast cancer. Consistent pathological staging, utilization of other prognostic predicators, and systemic therapy on a more widespread scale may help to improve the clinical outcome

Outcome of stage I carcinoma of the breast at the University Hospital of the West Indies (1982-1988)

The five-year survival data for 62 patients with Stage I breast cancer treated at the University Hospital of the West Indies (UHWI) between 1982 and 1988 were evaluated to determine which factors were affecting outcome. The overall survival rates (66.7 percent) were below those quoted from large multicentre studies from North America, Western Europe and Australia. The most significant survival differences emerged in the subset of postmenopausal patients with cliniclly staged disease who fared worse than those with pathologically staged disease. These data suggest that clinical staging is inadequate for the management of Stage I breast cancer. Consistent pathological staging, utilization of other prognostic predicators, and systemic therapy on a more widespread scale may help to improve the clinical outcome (AU)

Wiskott-Aldrich Syndrome in a Jamaican

A 3-week-old boy presented with severe thrombocytopenia and recurrent infections. He was subsequently found to have Wiskott-Aldrich Syndrome, a rare X-linked disorder. Splenectomy was performed and he died of post-splenectomy sepsis despite prophylatic antibiotic therapy. This is the first recorded case in the English-speaking Caribbean.

Wiskott-Aldrich Syndrome in a Jamaican

A 3-week-old boy presented with severe thrombocytopenia and recurrent infections. He was subsequently found to have Wiskott-Aldrich Syndrome, a rare X-linked disorder. Splenectomy was performed and he died of post-splenectomy sepsis despite prophylatic antibiotic therapy. This is the first recorded case in the English-speaking Caribbean. (AU)

Use by visitors of the services of the Queen Elizabeth Hospital, Barbados, W.I

This paper analyses data for 1990 culled from the medical records of the Queen Elizabeth Hospital, Barbados and examines the use of inpatient and emergency services by visitors to Barbados. The 473 visitors admitted represented 2.1 per cent of all admissions. The records of 425 contained information on country of origin: 145 were from non-Caribbean and 280 from Caribbean countries. The distribution by country of non-Caribbean visitors was the same as that of regular tourist arrivals - The majority came from the USA, Canada and the UK. Caribbean visitors represented 14.4 per cent of the tourists, but accounted for 65.9 per cent of visitor admissions. Non-Caribbean visitors were 85.6 per cent of tourists, but 34.1 per cent of admissions. Young patients predominated among Caribbean, and older patients among non-Caribbean. Accidents, cardiovascular disease, alcohol-related illnesses and near drowning were commoner in the non-Caribbean visitors, while cancer and obstetrical/gynaecological problems were commoner in Caribbean visitors. Seven per cent of visitor admissions went to the Intensive Care Unit as against 0.15 per cent of other patients. The average hospital stay of visitors was 11.7 days compared with 7.0 days for Barbadians. There were 898 visitors treated in the Accident and Emergency Department and the commonest problems were lacerations, abrasions and infections. The UK provided most of these patients. These data show that there is appreciable visitor use of the public health services. Non-Caribbean visitors use them because they fall ill on holiday, but many Caribbean visitors may come specifically for health care. The cost to the Barbadian health service is not insignificant: at the 1990 estimated bed-day cost of Bds$250, it represents a cost of Bds$1.1 million per annum to the Government for inpatient services alone, or 2 per cent of total hospital costs.

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)

Glanzmann's thrombasthenia and pregnancy

Glanzmann's thrombasthenia is a rare congenital disorder of platelet function manifesting as defective primary haemostasis. Bleeding episodes often require platelet transfusions, and allo-immunization to donor platelets may occur. The problems of ensuring adequate haemostatic potential for delivery of an allo-immunized pregnant female with Glanzmann's thrombasthenia are presented (AU)

Megaloblastic change in sickle cell disease obscured by genetically determined microcytosis

Changes in mean cell volume in sickle cell disease must be judged against the patient's own steady state values. Two cases are reported in which megaloblastic erythropoiesis was overlooked because of genetically determined microcytosis. The effect of megaloblastic change was to increase the mean cell volume(MCV) but values remained in the range normal for other patients (AU)