Chemical composition of urinary tract stones at the University Hospital of the West Indies / Composición química de las piedras del tracto urinario en el Hospital Universitario de West Indies

Urinary tract stones occur frequently with the incidence being about one to fifteen per cent worldwide. Patients may be asymptomatic or sometimes they may present with haematuria. Severe lumbar pain radiating to the loin requiring immediate analgesic treatment may occur. Stones generally consist of organic and inorganic material. The organic material may be present in the nidus and can contribute up to about 2.5% of the total weight. Inorganic minerals make up the bulk of the stone. Data are presented for the inorganic minerals present in the stones seen at the University Hospital of the West Indies over a 25-year period. Six hundred and forty-one (445 males and 196 females) stones were analyzed by routine chemical methods. Calcium was the main constituent, being seen in 93.9% of the stones. This was followed by oxalate 60.1%, urate 37.0%, bicarbonate 16.5% and magnesium 8.6%. There were four cystine containing stones. Treatment includes medical management for the underlying cause and surgical methods for the removal of the stones. Chemical methods of analysis of the stones has its limitations and should be replaced by more sophisticated methods eg X-ray diffraction crystallography which would give more accurate details of the structure of the stones.

Las piedras del tracto urinario se presentan frecuentemente con una incidencia de aproximadamente uno a quince por ciento a nivel mundial. Los pacientes pueden ser asintomáticos o presentarse con hematuria. Puede producirse dolor lumbar severo que se irradia a toda la región lumbar y que requiere tratamiento analgésico inmediato. Las piedras generalmente están formadas por material orgánico e inorgánico. El material orgánico puede estar presente en el nido y puede contribuir hasta aproximadamente 2.5% del peso total. Los minerales inorgánicos constituyen la mayor parte de las piedras. Se presentan datos de los minerales inorgánicos presentes en las piedras vistas en el Hospital Universitario de West Indies en un periodo de 25 años. Seiscientos cuarenta y una (445 varones y 196 hembras) piedras fueron analizadas mediante métodos químicos de rutina. El calcio fue el constituyente principal, observándosele en el 93.9% de las piedras. El mismo fue seguido por el oxalato (60.1%), el urato (37.0%), el bicarbonato (16.5%) y el magnesio (8.6%). Había cuatro cistinas que contenían piedras. El tratamiento incluye el manejo médico de la causa subyacente y los métodos quirúrgicos para la eliminación de las piedras. Los métodos químicos de análisis de las piedras tienen sus limitaciones y deben reemplazarse por métodos más sofisticados, tales como la cristalografía por difracción de rayos X. que daría detalles más exactos de la estructura de las piedras.

Autoantibodies, human T lymphotropic virus type 1 and type 1 diabetes mellitus in Jamaicans

The clinical characteristics, autoantibody profiles and seroprevalence of human T lymphotropic virus Type 1 (HTLV-1) were assessed in 30 Jamaican patients with Type 1 diabetes mellitus. Two hundred and fifty-two blood donors and 108 patients with Graves' disease were included as controls for the HTLV-1 component of the study. The mean age of onset of diabetes mellitus was 20.5 +/- 9.2 years and the mean duration of diabetes mellitus was 10.5 +/- 6.1 years. The remarkable clinical data included an absence of other associated organ-specific autoimmune diseases, and clinical evidence and history of congenital rubella in one patient. Islet cell cytoplasmic antibodies (ICA) were absent but 17 (5/30) of the diabetic patients tested positive for glutamic acid decarboxylase (GAD) antibodies. No other organ-specific autoantibodies were detected but non-organ-specific autoantibodies were present in 9 (30) of the sera of diabetic patients. The seroprevalence of HTLV-1 in the patients with diabetes mellitus was significantly higher than that in the healthy controls (17 (5/30) versus 4 (11/252), p = 0.05). Autoantibodies were found in the sera of 4/5 (80) of the diabetic patients who were positive for HTLV-1. None of the patients with onset of diabetes mellitus below age 15 years was HTLV-1 positive. The likely polyaetiological nature of Type 1 diabetes mellitus in Jamaicans is being further investigated at the molecular level.

The influence of persistent hyperglycaemia on hyperfibrinogenaemia and hyperviscosity in diabetes mellitus

The effect of hyperglycaemia on hyperfibrinogenaemia and its consequence on plasma viscosity was investigated in 69 diabetic patients during the course of hypoglycaemic treatment. Glycaemic control was assessed by measurement of glycosylated haemoglobin (HbA1). Plasma fibrinogen concentration (PFC) was determined by a clot-weight method. The relative plasma viscosity (RPV) was measured by capillary viscometry. The mean PFC and RPV were significantly (p < 0.001) elevated in the diabetic patients as compared with a non-diabetic control group. Both PFC and RPV showed a distinct, step-wise increase with progressively poorer glycaemic control. The data strongly indicate that persistent hyperglycaemia is associated with a frank hyperfibrinogenaemia and hyperviscous plasma in most of the diabetic patients studied. These abnormal haemorrheological changes could impact adversely on both the haemostatic process and circulation in diabetic patients.

Toxic effects of ackee oil (Blighia sapida L) following subacute administration to rats

Subacute intraperitoneal administration of the lipid portion of the unripe ackee arillus, referred to as "ackee oil", resulted in marked neutropenia (p<0.001) and increase in platelets (p<0.01) without anaemia, in rats. Blood urea, sodium amd aspartate aminotransferase levels were significantly decreased but glucose and bilirubin levels were similar to those of controls. The lungs showed areas of petechial haemorrhaghes and a dose-related perivascular and peribronchial mononuclear cell infiltration. The pulmonary toxicity may be interpreted as a hypersensitive reaction to ackee oil. Further research is in progress on the neutropenic effects of ackee oil.

Biochemical abnormalities in multiple myeloma

Monoclonial gammopathies can either be benign or more commonly malignant. The commonest disease associated with it is multiple myeloma. Over the seven-year period 1984-1990, two hundred and thirty-four monoclonal gammopathies were seen at the University Hospital, Jamaica. Multiple myeloma was diagnosed in one hundred and fifty-six cases (84 males and 72 females). The diagnosis of most of the others were not known as the samples came from other institution. Of the patients with myeloma, the most common immunoglobulin type was IgG followed by IgA and then pure light chain disease. Only in about half of the cases where urine was analysed was Bence-Jones protien found. The majority of the cases had abnormal total serum protein, albumin and total globulin concentrations. Most of the cases also were in renal failure. Hypercalcaemia, hyperphoshataemia, elevated alkaline phosphate, gammaglutamyl transferase and aspartate aminotransferase occured in about one-third of them. These results were not much different from those reported in other countries