Comparison of Computed Tomography Pulmonary Angiograms at the University Hospital of the West Indies, Jamaica with Reported Cases in Literature / Comparación de las Angiografías Pulmonares por Tomografía Computarizada en el Hospital Universitario de West Indies, Jamaica, con los Casos Reportados en la Literatura

ABSTRACT Objective: This study was undertaken to determine the positive rate for computed tomography pulmonary angiograms (CTPAs) at the University Hospital of the West Indies (UHWI), to compare the positive rate at the UHWI to that reported in the literature and to compare the rates of positive CTPAs between the genders. Method: Data were obtained from the databases of the Radiology Department of the UHWI. All CTPAs performed to confirm a clinical diagnosis of pulmonary embolism and the results issued during the period January 1st 2013 and December 31st 2013 inclusive were reviewed. Only initial examinations of adequate diagnostic quality were included in the study. Results: Three hundred and thirteenth CTPAs were performed for initial diagnosis of pulmonary embolism. Sixteen examinations were excluded for inadequate diagnostic quality. Two hundred and ninety-seven examinations on 223 females and 74 males were included in the study. The means for age were 49.7 years and 55.1 years, respectively; the difference in the means was significant (p < 0.05). Ninety-four examinations (31.6%) on 22 males (7.4%, mean age 58.4 years) and 72 females (24.2%, mean age 57.5 years) were positive for pulmonary embolism. The difference in the means was not significant (p = 0.8). On Chi-squared test there was no significant difference in the percentage of positive CTPAs between males and females (p = 0.7). Conclusions: The percentage of positive CTPAs at the UHWI is high. There was no significant difference between the genders in the percentage of positive CTPAs or the mean age at which pulmonary emboli were detected.

ABSTRACT Objetivo: Este estudio se llevó a cabo con el propósito de determinar la tasa positiva de las angiografías pulmonares por tomografía computarizada (APTC) en el Hospital Universitario de West Indies (UHWI), comparar la tasa positiva en el UHWI con la que se reporta en la literatura, y comparar las tasas de APTC positivas entre géneros. Método: Se obtuvieron datos de las bases del Departamento de Radiología de UHWI. Se examinaron todas las APTC realizadas para confirmar un diagnóstico clínico de embolia pulmonar y los resultados emitidos durante el período del 1ero de enero de 2013 y 31 de diciembre de 2013 inclusive. En el estudio se incluyeron únicamente exámenes iniciales de calidad diagnóstica adecuada. Resultados: Trecientos trece APTC fueron realizadas para el diagnóstico inicial de embolia pulmonar. Se excluyeron 16 exámenes por poseer una calidad diagnóstica inadecuada. Doscientos noventa y siete exámenes de 223 hembras y 74 varones fueron incluidos en el estudio. Los promedios de edad fueron 49.7 años y 55.1 años respectivamente. La diferencia de los promedios fue significativa (p < 0.05). Noventa y cuatro exámenes (31.6%) de 22 varones (7.4%, edad promedio 58.4 años) y 72 hembras (24.2%, edad promedio 57.5 años) fueron positivos a la embolia pulmonar. La diferencia de los promedios no fue significativa (p = 0.8). En la prueba de Chi-cuadrado no hubo diferencias significativas en el porcentaje de APTC positivas entre varones y hembras (p = 0.7). Conclusiones: El porcentaje de APTC positivas en el UHWI es alto. No hubo diferencias significativas de género en el porcentaje de APTC positivas o la edad promedio a la que se detectaron los émbolos pulmonares.

Ultrasound detected asymptomatic cholelithiasis: an age-based protocol for management / Colelitiasis asintomática detectada por ultrasonido: un protocolo basado en la edad para el tratamiento

OBJECTIVE: This study was undertaken to examine the correlation between age and gender and the presence of ultrasound findings of acute or chronic cholecystitis in adult patients with cholelithiasis. METHOD: The demographic data of all patients diagnosed with cholelithiasis and cholecystitis on ultrasound between January 1, 2002 and December 31, 2006 were reviewed and statistically analysed. RESULTS: Five hundred adults, 373 females (74.6%) and 127 males (25.4%), were diagnosed with cholelithiasis during the five-year period. Ages ranged from 18 to 94 years with a median age of 47 years. The diagnosis of cholecystitis was equivocal in 11 patients. Of the remaining 489, 22.1% (108) were diagnosed as positive for cholecystitis by ultrasound, the remaining 77.9% (381) being negative. No association was found between gender and cholecysytitis in bivariate analysis, (χ² = 1.82, df =1, p = 0.177). A statistically significant relation was found between age group category and ultrasound-determined cholecystitis status (χ² = 32.58, df = 4, p < 0.001). Higher proportions of persons in the 20-39-year (40.9%) and 40-59-year (20.4%) age groups had cholecystitis on ultrasound examination compared to other age categories where corresponding rates were approximately 11% or less. CONCLUSION: Patients 60 years or older who were diagnosed with cholelithiasis on ultrasound examination were less likely to have cholecystitis than younger patients.

OBJETIVO: Este estudio fue emprendido para examinar la correlación entre edad y género, y los hallazgos en ultrasonidos de colecistitis aguda o crónica en pacientes adultos con colelitiasis. MÉTODO: Se revisaron y analizaron estadísticamente los datos demográficos de todos los pacientes diagnosticados con colelitiasis y colecistitis a partir de ultrasonidos realizados entre el enero 1 de 2002 y diciembre 31 de 2006. RESULTADOS: Quinientos adultos - 373 hembras (74.6%) y 127 varones (25.4%) - fueron diagnosticados con colelitiasis durante el periodo de cinco años. Las edades fluctuaron de 18 a 94 con una edad mediana de 47 años. El diagnóstico de colecistitis fue equívoco en 11 pacientes. De los restantes 489, 22.1% (108) fueron diagnosticados positivos a la colecistitis por ultrasonido, resultando los restantes 7.9% (381) negativos. No se halló ninguna asociación entre el género y la colecistitis en el análisis bivariado, (χ² = 1.82, df =1, p = 0.177). Se halló una relación estadísticamente significativa entre la categoría del grupo etario y la condición de colecistitis determinada por el ultrasonido (χ² = 32.58, df = 4, p < 0.001). Las proporciones más altas de personas en los grupos de edad de 20 - 39 años (40.9%) y 40 - 59 años (20.4%) tenían colecistitis al ser examinadas con ultrasonido, comparadas a otras categorías de edad en las que las tasas correspondientes fueron aproximadamente 11% o menos. CONCLUSIÓN: Los pacientes de 60 o más años de edad, a quienes se les diagnosticó colelitiasis en el examen de ultrasonido, presentaban menos probabilidad de tener colecistitis que los pacientes más jóvenes.

Stroke subtypes on imaging in a Jamaican population a hospital-based study: estudio en un hospital / Subtipos de accidente cerebrovascular en la imagen médica en una población Jamaicana

OBJECTIVE: To examine the pattern of stroke subtypes found on Computed Tomography (CT), Magnetic Resonance Imaging (MRI) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. METHOD: A retrospective review was conducted for all patients diagnosed with stroke and who were subjected to CT or MRI evaluation at UHWI between January 2001 and December 2004. Data were collected for patient age and gender and type of stroke. RESULTS: Four hundred and thirty-three patients were identified and classified as having cerebral infarct, intra-parenchymal haemorrhage or subarachnoid haemorrhage. There were 414 patients who had CT scans and 19 had MRI scans. Within and across genders, over 80% suffered infarcts with no significant statistical difference between male and female patients. Subarachnoid haemorrhage was the least frequent subtype and occurred in younger patients. CONCLUSION: The pattern of stroke subtypes seen in this population was similar to that of Australian and European cohorts of patients but differed from that reported in Asians. Ischaemic infarct was the most frequent stroke subtype followed by intra- parenchymal haemorrhage and subarachnoid haemorrhage. There was no gender predilection for any specific type of stroke.

OBJETIVO: Examinar el patrón de los subtipos de accidente cerebrovascular encontrados en las imágenes de TAC y MRI en el Hospital Universitario de West Indies (HUWI), Kingston, Jamaica. MÉTODO: Se realizó un examen retrospectivo de todos los pacientes con diagnóstico de accidente cerebrovascular, sometidos a evaluación mediante TAC o MRI, entre enero 2001 y diciembre 2004. Los datos fueron recogidos teniendo en cuenta la edad y el género del paciente, así como el tipo de accidente. RESULTADOS: Cuatrocientos treinta y tres (433) pacientes fueron identificados y clasificados como pacientes con un infarto cerebral, hemorragia intraparenquimal o hemorragia subaracnoidea (HSA). Hubo 414 pacientes examinados con TAC y 19 con MRI. Dentro de ellos, ambos géneros incluidos, más del 80% sufrió infartos sin que hubiese diferencias estadísticas significativas entre hombres y mujeres. La hemorragia subaracnoidea fue el tipo menos frecuente, y se produjo en pacientes jóvenes. CONCLUSIÓN: El patrón de subtipos de accidente cerebrovascular en esta población fue similar al de cohortes de pacientes australianos y europeos, pero diferente al reportado para los asiáticos. El infarto isquémico fue el subtipo de accidente cerebrovascular más frecuente, seguido por la hemorragia intraparenquimal y la hemorragia subaracnoidea. No hubo preferencia de géneros en relación con ninguno de los tipos específicos de accidente cerebrovascular.

Ultrasound and white blood cell counts in suspected acute appendicitis / Ultrasonido y conteo de glóbulos blancos en casos de sospecha de apendicitis aguda

The use of radiological studies as diagnostic tools in patients with suspected acute appendicitis has increased recently. In this setting, abdominal ultrasonography is viewed as a possible means of avoiding unnecessary surgery. This retrospective study of patients who underwent laparotomy for suspected acute appendicitis was undertaken to determine the sensitivity and specificity of ultrasound in diagnosing acute appendicitis and the frequency of leucocytosis in patients in whom the diagnosis was confirmed by histology. The ultrasound and surgery registers were reviewed to identify 254 referrals for abdominal ultrasound between January 2001 and December 2002 because of a clinical suspicion of acute appendicitis. Of these cases, 223 did not proceed to surgery. The study sample comprised 31 patients who had appendectomies after abdominal ultrasonography. The ultrasound reports, pathological diagnoses and white blood cell counts of these patients were obtained and formed the basis for the analysis. A histological diagnosis was available for 30 cases, in 17 of whom appendicitis was confirmed In these patients, positive ultrasound and leucocytosis were present in five (29) and nine (53) respectively. Ultrasound showed 92specificity and 29sensitivity for the pre-operative diagnosis of appendicitis. The positive predictive value of ultrasonography (83) was higher than that of leucocytosis (69). The sensitivity and specificity of ultrasound and leucocytosis in this study indicate limited utility as preoperative diagnostic tools.

El uso de estudios radiológicos como herramientas de diagnóstico en los pacientes con sospecha de apendicitis aguda ha aumentado recientemente. En este escenario, la ultrasonografía abdominal se ve como un posible medio de evitar una cirugía innecesaria. Este estudio retrospectivo de pacientes sometidos a laparotomía por sospecha de apendicitis aguda, fue realizado a fin de determinar la sensibilidad y especificidad del ultrasonido a la hora de diagnosticar la apendicitis aguda así como la frecuencia de leucocitos, en pacientes en quienes el diagnóstico fue confirmado mediante histología. Se revisaron las historias de ultrasonido y cirugía con el propósito de identificar 254 remisiones para la realización de ultrasonido abdominal entre enero de 2001 y diciembre de 2002, debido a una sospecha clínica de apendicitis aguda. De estos casos, 223 no pasaron a cirugía. La muestra del estudio abarcó 31 pacientes a los que se les realizaron apendicectomías tras del ultrasonido abdominal. Se obtuvieron los reportes de los ultrasonidos, los diagnósticos patológicos y los conteos de glóbulos blancos de estos pacientes. Estos reportes constituyeron la base del análisis. Se tuvo a disposición un diagnóstico histológico en 30 casos, en 17 de los cuales se confirmó apendicitis. En estos pacientes, el ultrasonido resultó positivo en cinco casos (29%) y la leucocitosis estuvo presente en nueve (53%). El ultrasonido arrojó un 92% de especificidad y 29% de sensibilidad para el diagnóstico preoperativo de la apendicitis. El valor predictivo positivo de la ultrasonografía (83%) fue mayor que el de la leucocitosis (69%). En este estudio, la sensibilidad y especificidad del ultrasonido y la leucocitosis, indican una limitada utilidad tanto del ultrasonido como del conteo de glóbulos blancos como instrumentos preoperativos de diagnóstico.

Ultrasonography of the lower limbs for deep vein thrombosis at the University Hospital of the West Indies. A five-year analysis

A study was conducted on all patients referred to the ultrasound service of the radiology department of the University Hospital of the West Indies, Kingston, Jamaica, for evaluation of a clinical diagnosis of thrombosis of the deep veins of the lower limb, during the period January 1, 1995, to December 31, 1999. The calf veins were not routinely examined; this study was limited to the popliteal, superficial and deep femoral veins. Two hundred and seventy-four females and 104 males were referred. Seventy females and 32 males had ultrasound findings of deep vein thrombosis (DVT). The significant findings were that the male:female ratio for confirmed DVT was approximately 1:2; 26 of referrals had DVT on ultrasound; DVT was more common on the left and the popliteal vein (48) and the superficial femoral vein (47) accounted for most documented cases of DVT but thrombosis of the profunda femoral vein was unusual accounting for only 5 of cases.

Male breast cancer. An analysis of four cases and review of the literature

We report the clinicopathological 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 exhibit 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.

Clear cell sarcoma of soft parts. A case report and review of the literature

The case of a 25-year-old woman with recurring and metastasizing clear cell sarcoma of soft parts (CCS) is presented. The clinical setting and pathological appearance were in agreement with the original cases described. This report serves to highlight the clinico-pathological features of this rare and aggressive malignancy with specific reference to prognostic markers and treatment.

Retrospective audit of blood donation at a Hospital-based blood centre: Implications for blood product supply and safety

An audit of blood donation at the University Hospital of the West Indies (UHWI) was performed between January 1995 and December 1998. During these four years, 21,733 persons attended the blood collection centre and 6,711 (30.8 percent) were rejected as donors. Females accounted for 3, 054 (45.6 percent) of rejected donors while 3,647 (54.4 percent) were males. Females were rejected primarily because of low haemoglobin levels, while rejection was most frequently attributed to symptoms of the common cold and recent drug use. One hunderd and two rejected donors (1.5 percent) admitted to recent treatment of a sexually transmitted disease, and 138 (2.0 percent) presented within 16 weeks of a prior donation. Of 15,022 units donated, altruistic voluntary donations accounted for 307 (2 percent) and 53 (0.3 percent) were autologous donations. Seven hundred and four units (4.6 percent) were discarded because of positivity on initial testing for a marker of transmissible infection. Overall prevalence for markers of infection was 2.5 eprcent for HTLV-1, 0.9 percent for Hepatitis B and 0.4 percent for HIV I/II. Donations at the University Hospital of the West Indies (UHWI) collection centre contributed 15.8 percent of the national blood supply for the period under study.

Prevalence of risk factors in breast cancer patients at the University Hospital of the West Indies

The records of 120 consecutive patients diagnosed with carcinoma of the breast were examined between July 1996 and June 1999 in order to estimate the prevalence of established risk factors for this disease. Early menarche was present in 5.5 percent of patients, while 36 subjects (30 percent) were mulliparous and 6 (5 percent) had a first live birth after age 30 years. Four subjects had a previous biopsy with histological features of atypical hyperplasia. Fifteen subjects (12.5 percent) had one or more affected first degree relatives. Fifty-four percent of subjects possessed none of the risk factors examined in this study while 36 percent had a single risk factor and 10 percent possessed two risk factors. There was no significant clustering of risk factors in the group of patients aged thirty-five years or less. Larger studies should be encouraged to identify the risk factors which operate in our population and the degree to which published predictive variables are applicable.

Solid and Papillary epithelial neoplasm. Ultrasound and CT features of an unusual pancreatic tumour

The ultrasonographic and computed tomography features of four cases of solid and papillary epithelial neoplasm (SPEN) - a rare pancreatic tumour - are described. Although not diagnostic, the presence of these imaging features in the typical clinical setting may permit pre-operative radiological diagnosis and facilitate planning for curative surgery for this malignant tumour which has an excellent prognosis even without further adjuvant therapy.

Cancrum oris (noma) in a patient with acute lymphoblastic leukaemia. A complication of chemotherapy induced neutropenia

Cancrum oris (noma) has been most commonly described in malnourished debilitated children with poor oral hygiene following systemic childhood infections such as measles, pertussis or scarlet fever. We describe a patient who developed this condition during a period of profound neutropenia following cytotoxic chemotherapy for acute lymphoblastic leukaemia.

Autoimmune haemolytic anaemia, immune thrombocytopenia, and leucopenia - an unusual presentation of hodgkin's disease

We report an unusual case of modular sclerosing Hodgkin's disease in a 17 year old women presenting with intermittent fever, progressive weight loss and enlarged cervical and anxillary lymp nodes. Laboratory test revealed severe Coombs' positive haemolytic anaemia, and progressive thrombocytopenia and leucopenia, associated with erythroid, myeloid and megakaryocytic hyperplasia, but with no evidence of lymphomatous infiltration in the bone marrow. Transfusion of compatible blood became possible only after prednisone therapy and a single intravenous dose of vincristine. Appropriate chemotherapy led to normalization of the peripheral blood counts and a negative direct Coombs' test.