Closure of aorto-pulmonary window in infancy using cardiopulmonary bypass

A case is described of a Jamaican Negro female infant with resistant cardiac failure due to an aorta-pulmonary window which was successfully closed using a cardio-pulmonary bypass operation (AU)

Effect of triamterene on leucocyte sodium and potassium levels in heart disease

Sodium and potassium levels in plasma and leucocytes and the sodium efflux rate constants of leucocytes were measured in patients with congenital heart disease not on treatment, patients with valvular heart disease being treated with digoxin and conventional diuretics showed low cellular potassium levels, low sodium levels. Patients given triamterene showed a rise in potassium levels in plasma and cells and in the sodium efflux rate constant (AU)

Destroyed lung: a report of cases in West Indians and Australian Aborigines

A series of patients with total destruction of one lung by bronchiectasis and a normal contralateral lung is reported. Eight cases were West Indians of Negro race and four were Australian Aborigines. The bronchiectasis appears to be of post-effective type and is related to the poor social conditions under which the affected people live. It has also been noted in other developing countries or in under-privileged races in developed countries.(AU)

The possible relationship between cardiac glycogen levels, ouabain toxicity and the anti-arrhythmic effect of anacardium occidentale

Using the open chest dog with the heart in situ, the influences upon the cardiac glycogen by fasting, anacardium occidentale, and ouabain were studied. Fasting elevated the cardiac glycogen while intravenous infusion of glucose did not increase the cardiac glycogen. Anacardium occidentale elevated the cardiac glycogen after a slow intravenous infusion. The depletion of cardiac glycogen occurred concurrently with the onset of ectopic beats due to ouabain toxicity, and the toxic dose of ouabain was significantly increased in relation to the high cardiac glycogen. The stress of cardiac surgery significantly depleted the glycogen content of the human heart, and this depletion was not related to trauma or the time the patient was on cardio-pulmonary by-pass. It is concluded that: (a) anacardium occidentale protects against ouabain arrhythmias by elevating the cardiac glycogen, (b) there is a critical cardiac glycogen level below which ouabain readily becomes toxic, and (c) surgery on the heart in the human depletes its glycogen stores (AU)

Fibroxanthomatous pseudotumour of the lung

The clinical, radiological and pathological features of fibroxanthomatous pseudotumour of the lung in a 17-year-old Jamaican female Negro are described. The patient was symptom-free 4 years after treatment by conservative surgery. The condition is extremely rare. Its aetiology and pathogenesis are discussed. (Summary)

Plasma cell granuloma of the lung

The clinical, radiological and pathological features of three cases of plasma cell granuloma of the lung are described. This represents the first report of such tumours from the University Hospital of the West Indies, which were diagnosed only within the last three years. Distinction must be made between plasma cell granuloma and plasmacytoma of the lung, an exceedingly rare tumour which may or may not be associated with multiple myelomatosis (AU)

Pulmonary artery banding for ventricular septal defect in infancy

Experiencing with pulmonary artery banding in three ill infants with large ventricular septal defects is reported for the first time from the Commonwealth Caribbean. There was a successful outcome in all three cases. There was a minimal follow-up of one year. It is suggested that the systolic pressure gradient across the band, after a satisfactory steady state has been achieved, may be a useful additional measurement in the evaluation of the resultant haemodynamic state. (AU)

Tracheobronchomegaly

Over fifty cases of tracheobronchomegaly reported in the literature are reviewed and two new cases are described. The radiological appearances of this rare condition are described and its concomitant occurrence with bronchiectasis is noted. The condition is thought to be due to faulty development of the connective tisssues of the tracheobronchial tree. However, a study of the age of presentation showed that the majority presented in the third or later decades which suggests that it is an acquired rather than a developmental anomaly. (AU)

Acquired pulmonary stenosis due to compression by a bronchiogenic cyst

A case of pulmonary stenosis due to extrinsic compression of the pulmonary artery and right ventricular infudibulum is reported. It is believed that this is the first such case recorded in the English literature where the cause of the compression was a bronchiogenic cyst (AU)

Intralobar pulmonary sequestration in association with bilateral systemic arterialization of the lungs

Over 250 cases of intralobar pulmonary sequestration have now been reported (Ranniger and Valvassori, 1964). The diagnosis which may be suscepted on the clinical, plain radiograph and bronchographic findings, depends on the angiographic or operative demonstration of an aberrant systemic arterial supply to the affected segment. The preoperative angiographic visualization of this pulmonary systemic arterialization arising from the thoracic or abdominal aorta either as a single large vessel (McDowell, Robb, and Indyk, 1955) or as multiple small arteries (Turk and Lindskog, 1961) to a large extent eliminates the operative hazards (Harris and Lewis, 1940). This paper reports an unusual case of pulmonary intralobar sequestration in association with bilateral aberrant systemic arteries. The angiographic and operative findings suggest that this may be a case of bilateral pulmonary sequestration (Summary)

Aspects of lung cancer in Jamaica

The incidence of lung cancer in the approximately one- half million population living in the parish of Kingston and St. Andrew of Jamaica- a tropical developing country- has been investigated for the years 1958-1970 inclusive. When compared- on an age standardized basis- with figures published fr om other areas, Jamaica's figures appear to be substantially above those from Africa, but much lower than those from Britain and the United States (table 12). The incidence appears to be rising both in males and females (fig.1, table 12). Clinical and pathologic data on 105 cases of lung cancer were obtained through the postmortem and surgical pathology services of the University Hospital of the West Indies, a 500-bed general hospital. The three main histologic types were equally represented at postmortem, but the squamous carcinoma type was more frequently seen in the surgical pathology material. The patients had an inadequate follow-up and were small in number, the data, therefore, did not allow an evaluation of the use of the W.H.O. histologic classification as to its prognostic significance. The duration of symptoms from onset to death or operation was gene rally less than 6 months (AU)

Palliative surgery for congenital heart disease in small children - abstract

Ten small children with severe congenital heart disease have had palliative surgical procedures performed with good clinical results and without mortality at the University Hospital of the West Indies. Seven of these were cases of Tetralogy of Fallot and 3 were cases of large ventricular septal defects. It is planned to do a curative surgical operation for all these patients when they are old enough to permit the safe use of cardiopulmonary bypass. The 7 cases of Tetralogy of Fallot were aged from 11 months to 5 years. A Blalock-Taussig shunt was performed in the first 3 cases, and a shunt between the ascending aorta and right pulmonary atery was carried out in the last 4 cases. The indications for surgery were: (a) severe cyanosis with gross exercise intolerance (5 cases), and (b) severe paroxysmal cyanotic attacks not responding to "conservative" measures (2 ases). One patient, aged 4 years, had not been able to stand or walk. Another had a history of hypoxic convulsions. There were two post-operative complications - post-intubation laryngeal swelling, and left iliac vein thrombosis secondary to a previous saphenous vein exposure in the groin for intravenous infusion. The follow-up period ranged from 3 months to 31/2 years. All the patients did well. Their effort tolerance was markedly improved and cyanosis was absent or nearly so. The 3 cases of venticular septal defects were aged 3 months, 11 months, and 1 year. They had banding of the pulmonary artery performed for severe congestive cardiac failure which did not respond to intensive conservative therapy with diuretics and digoxin. In one case the diagnosis was confirmed pre-operatively by cardiac catherization which demonstrated a large left to right shunt with a pulmonary: systemic flow ratio of 7:1. In the other 2 cases the diagnosis was made on clinical radiological and electrocardiographic evidence. At surgery, a patient ductus arteriosus was excluded and the presence of a typical thrill over the anterior surface of the right ventricle and a large pulmonary artery were demonstrated. There were no post-operative complications directly attributable to the surgery. All 3 patients are still attending regularly for follow-up which ranged from 3 to 7 months in January, 1972. Two have shown marked improvement but the third is only moderately improved (AU)

Cardiothoracic surgical problems in Jamaica - abstract

Statistics of the incidence of cardiothoracic surgical problems in Jamaica are incomplete. An attempt is made to compile currently available data. The potential sources of data are the records of the University Hospital, Kingston Public Hospital, George V Sanatorium, the Registrar General's office and private practitioners. Some published data also exist. Most of the records are incomplete and the information is not available in a way which would highlight the major cardiothoracic surgical problems of Jamaica. Because of this, the author, as the person most engaged to any significant degree in the practice of cardiothoracic surgery in Jamaica, reports in this preliminary communication on his own experience at the University Hospital during the past two years. Thirty-seven major chest injuries were seen and 18 of these required admission to the Intensive Care Unit. Only a small percentage of all chest trauma comes under the author's care. One hundred and twenty diagnostic bronchoscopies were performed. For bronchogenic carcinoma only 6 lung resections were performed from a total of 52 cases. The incidence of this disease in Jamaica rose from 7.2 to 12.8 per 100,000 moles during the two 5-year periods ending in 1969 and it now rivals carcinoma of the oesophagus for a second place as a cause of death from malignant disease in the male. In the case of bronchiectasis, 8 lung resections were done frome amongst 17 cases seen by the author and proved by bronchography. In cardiac surgery, 24 closed and 24 open open-heart operations were performed. In the closed group, 13 patent ductuses were treated by division and suture, there were 2 shunt operations for Tetralogy at Fallot, 2 coarctations were relieved and 7 commissurotomies performed for rheumatic mitral stenosis. In the open-heart group requiring cardiopulmonary bypass, the following congenital cases were corrected without mortality: 4 V.S.D., 6 Tetralogy of Fallot, 3 pulmonary valve stenosis, 1 infundibular stenosis, 2 ostium secundum, 1 ostium primum primum, and 1 double outflow right ventricle. Only a small percentage of the potentially curable congenital cases have had the benefit of surgery. It is estimated that at least 150 of the 400 new cases born annually with congenital heart disease can be cured by surgery. For rheumatic heart disease, the following operations were performed: 3 mitral valve replacements, 1 aortic valve replacement, 1 aortic and mitral valve replacement and 1 mitral valveannulaplasty. Rheumatic heart disease is not uncommon and was present in 7.3 percent of 738 disease hearts examined at autopsy in adults over 17 years of age at U.H.W.I. In a miscellaneous group requiring major surgery, the following opertions were performed; 3 thymectomies for myasthenia gravis, 3 lung resections, 5 decortications, 9 mediastinal tumours were removed, 2 oesophagectomies, 4 colon bypass operations for oesophageal obstruction, and 11 operations on major vessels. In a miscellaneous number of surgical investigations, the following procedures were performed; 9 scalene node clearances, 7 anterior mediastinoscopies, 11 thorascopies and 33 oesophagoscopies. Carcinoma of the oesophagus is regarded as a general surgical problem. Recent rapid strides in the surgery of coronary artery disease suggest that this common condition, which is present in 14.2 percent of adult diseased hearts, will be a major surgical service problem. Only a small percentage of the vast number of cases are seen at the University Hospital. The precise incidence of the various cardiothoracic surgical conditions require urgent investigation (AU)

Pre and post-operative findings in 18 cases of congenital heart disease treated by open heart surgery and cardiopulmonary bypass - abstract

The main purpose of this paper is to review the results of open heart surgery at the University Hospital of the West Indies in the past three years. 18 patients with congenital heart disease have had corrective surgery performed. The mean age at operation was 14.8 years ranging from 6.8 to 28 years. Seven of the patients were under 12 years and all but two 18 years or under at the same time of surgery: Five patients have had total correction of the Tetralogy of Fallot. Four of them, including a girls of 12 1/2 years who had pulmonary embolus one month after operation, are well at follow-up. One patient, a girl of 11 years, who was operated on in June, 1970, had evidence of right ventricular failure for six months, but when last seen was well although signs of tricuspid incompetence persist. Four patients with atrial septal defect, including one with an ostium primum defect and mitral incompetence, are well at follow-up with no evidence of heart disease. Four patients with ventricular septal defect have had their defect repaired. Two of these had significant pulmonary hypertension pre-operatively and one of these developed a leak post-operatively and has required a second operation. Four cases of pulmonary stenosis (two valvular, one infundibular and one both valvular and infundibular) have been corrected and all these patients are now well and active. A young woman of 27 who was thought on cardiac catheterization to have pulmonary stenosis, was found at operation to have a double outlet right ventricle and infundibular stenosis. Right and left outflow tract reconstruction carried out and although she had a stormy post-operative course was well when last seen. Pre- and post-operative electrocardiographic and radiological data will also be presented (AU)

An experimental study of pulmonary damage associated with intravenous injection of halothane in dogs

Holothane was injected intravenously into two groups of dogs and the effects on the lungs noted. The nine dogs of group I were unanaesthetized and received no ventilatory support following injection. The dogs were killed at varying time intervals after injection and the macroscopic and microscopic appearances were studied. In the six dogs of group II the the chests were open and they were artificially ventilated with 30 per cent oxygen and 70 per cent nitrous oxide at the time of injection. Serial biopsies were taken. The predominant lesions produced were generalized oedema and patchy alveolar haemorrhages. These changes were more severe in dogs of group I. The aetiology is conjectural, possibly being due to direct capillary damage or to embolization. The danger of accidental intravenous injection of halothane, a not unknown occurrence, is stressed (AU)

Ossified bronchial adenoma

A case of bronchial adenoma is reported which presented radiologically as an extensively calcified hilar mass on a routine chest radiograph of a patient undergoing surgery for varicose veins. This is of interest because, although bronchial adenomas may present in this way (Zellos, 1962; Baldwin and Grimes, 1967), calcification is not regarded as one of their radiological features. (AU)

"Coin" lesions of the chest: A review of fifteen cases seen in the University Hospital of the West Indies

A review of fifteen coin lesions of the chest from the University Hospital of the West Indies is presented. Six of the coin lesions were benign and nine were malignant. Twelve of the cases had no symptoms referable to the chest and were accidental findings on routine chest radiographs. The radiological appearances are discussed and it was found impossible to differentiate the benign from the malignant lesions. The impossibility of making a definite pre-operative diagnosis, the low operative mortality, the high incidence of malignancy, and the possibility of cure in malignant cases make surgical resection the treatment of choice. In three cases, other concomitant primary tumours were present (carcinoma of cervix, meningioma and pituitary tumour) and in a fourth case, a desmoid tumour developed in the scar on the chest wall following the resection of the coin lesions. (AU)

Myasthenia gravis in Jamaica - abstract

The purpose of this study is to assess the incidence, clinical features and results of treatment of myasthenia gravis as seen at the University Hospital in Jamaica. This paper deals with 50 cases. The clinical features and pitfalls in diagnosis are emphasized. Seven patients had thyrotoxicosis and seven showed muscular wasting. There were three with a thymoma only one of which was examined histologically and found to be malignant. Five patients became pregnant during their illness. Medical and surgical treatment are briefly discussed and the method of selection for each category is described. The best surgical result is obtained in young women with a rapidly progressive history. Thumectomy was performed in 19 patients with very good results. One patient died one year after surgery; he was a 60-year-old man with a malignant thymoma and severe generalized weakness. There was dramatic improvement after surgery in 15 patients. The remaining three improved slowly. Meticulous preoperative and post-operative managemant are essential(AU)

Lobar emphysema of infancy: case report of bilateral involvement with congenital heart disease

The fifth known case of bilateral lobar emphysema of infancy has been presented. This is the first bilateral case to occur in a Negro infant and the first to have associated congenital cardiac defect. The patient was successfully treated by bilateral lobectomies. Data from the previous bilateral cases is presented and the diagnosis and management discussed briefly. Striking similarities between all the cases have been noted and the antero-posterior chest X-ray appearance is pathognomic. The condition although rare should be considered in the differential diagnosis of respiratory distress in infancy (AU)

Endobronchial teratoma associated with bronchiectasis and bronchiolectasis

A teratoma in a young West Indian of Negro race is reported. The teratoma presented radiologically in the left upper lobe as an ill-defined shadow which contained a cresent-shaped translucent area and simulated a mycetoma. In addition, the left lung showed widespread nodular shadows. The left lung was resected and the teratoma was found to be endobronchial in position. This is a very rare site for a teratoma as only one of the 15 previously reported intrapulmonary teratomata may have been endobronchial. The remainder of the left lung remote from the tumour showed generalized bronchiectasis both radiologically and pathologically. The bronchiectasis was of follicular type and in addition there was widespread bronchiolectasis. The inflammatory reaction associated with the latter was responsible for the nodular shadows. The significance of these changes in relation to the teratoma is discussed. (AU)