Radical prostatectomy outcomes at the university hospital of the West Indies: 2000-2007 / Evolución clínica de la prostatectomía radical en el hospital universitario de West Indies: 2000-2007

OBJECTIVES: Prostate cancer is the commonest cancer in Jamaican men with an age-specific incidence of 65.5 per 100 000 and also the commonest cause of male cancer death. This study reports on the oncological outcome and morbidity after radical retropubic prostatectomy. SUBJECTS AND METHODS: The records of 116 patients with clinically localized prostate cancer (cT1c-T2) who underwent radical retropubic prostatectomy at the University Hospital of the West Indies from January 2000 to December 2007 were examined. Preoperative Prostate specific antigen (PSA), clinical stage and Gleason score were recorded. Operative time, blood loss, hospital stay and complications were assessed. Oncological outcome was assessed using biochemical progression. Disease progression was defined by PSA value of 0.4 ng/ml or greater. RESULTS: Mean patient age was 61 (43-75) years. The mean presenting PSA was 10.1 (2-25.1) ng/ml. Mean Gleason score on preoperative biopsy was 6. The commonest clinical stage was T1c (68%). Nodal involvement was seen in only one patient. The positive surgical margin rate was 15.5%. Mean operating time was 246 minutes and mean estimated blood loss was 1.44 L. The mean hospital stay was 6.9 days and 17% of patients developed minor complications, with no treatment or disease related deaths. Five-year biochemical-free survival was 78.4%. CONCLUSIONS: Oncological outcomes after radical retropubic prostatectomy in Jamaica appear to meet global standards with acceptable morbidity.

OBJETIVOS: El cáncer de la próstata es el cáncer más común entre los hombres jamaicanos con una incidencia específica por edad de 65.5 por 100 000, y es también la causa más común de la muerte por cáncer entre los hombres. Este estudio reporta la evolución clínica oncológica y la morbilidad tras la prostatectomía radical retropúbica. MÉTODOS: Se examinaron las historias clínicas de 116 pacientes con cáncer de próstata clínicamente localizado (cT1c - T2), sometidos a prostatectomía radical retropúbica en el Hospital Universitario de West Indies de enero de 2000 a diciembre 2007. Se registraron el antígeno específico de próstata (AEP) preoperativo, la etapa clínica y la puntuación de Gleason. Se evaluaron el tiempo operativo, la pérdida de sangre, la estadía hospitalaria, y las complicaciones. Se evaluó la evolución clínica oncológica usando la progresión bioquímica. La progresión de la enfermedad se definió por el valor del AEP de 0.4 ng/ml o mayor. RESULTADOS: La edad promedio de los pacientes fue 61 (43-75) años. El AEP promedio fue PSA 10.1 (2-25.1) ng/ml. La puntuación promedio Gleason en la biopsia preoperativa fue 6. La etapa clínica más común fue T1c (68%). Se observó compromiso de nódulos en sólo un paciente. La tasa de márgenes quirúrgicos positivos fue 15.5%. El tiempo promedio de operación fue 246 minutos y la pérdida de sangre promedio estimada fue 1.44 L. La estadía hospitalaria promedio fue de 6.9 días y 17% de los pacientes desarrollaron complicaciones menores, sin tratamiento o enfermedad relacionados con muertes. La supervivencia quinquenal libre del uso de productos bioquímicos fue 78.4%. CONCLUSIONES: Los resultados oncológicos después de la prostatectomía retropúbica radical en Jamaica muestran estar en correspondencia con los estándares globales con una morbilidad aceptable.

Infective endocarditis at the University Hospital of the West Indies. A revisit

Many countries have reported a change in the profile of infective endocarditis (IE) over the past three decades. The objective of this study was to evaluate the characteristics of IE from the autopsy service of the University Hospital of the West Indies (UHWI) during the last 15 years and to compare the results with that of an earlier study. There were 26 cases of IE during the period under review with a M:F ratio of 1.2:1. The ages ranged from 15 days to 74 years with a mean of 36.4 +/- 24.57 years. The largest number of cases (n = 7) occurred in the 10 to 19-year-age group. Cardiac predisposing factors were identified in 14 patients; nine with rheumatic heart disease, four with prosthetic valves and one with a bicuspid aortic valve. All vegetations were located on valves, the aortic being the most frequently involved followed by the mitral. Streptococcus species were the most common causative organisms followed by Staphylococcus aureus. Compared with the profile seen 15 years ago, there have been only minor changes in the characteristics of IE cases observed in the autopsy service at the UHWI

Heart weight and heart weight/body weight ratio in a Jamaican adult autopsy population. A preliminary study

The heart weight and heart weight/body weight (HW/BW) ratio were assessed in an adult autopsy population and compared with commonly used reference values. Examination of 127 adult post-mortem cases (80 males and 47 females, aged 17 to 91 years) revealed that the mean heart weight and the HW/BW ratios of both genders were significantly greater than the reference values, particularly so in the hypertensive patients. These findings suggest that the Jamaican adult heart is significantly heavier than values used from reference tables. In both genders, heart weight was significantly and positively correlated with body weight and body mass index but not height, for non-hypertensive and hypertensive subjects. The present data are preliminary and not comprehensive enough to establish definitive reference values for the Jamaican population. However, this information needs to be taken into consideration when making pathologic diagnoses using heart weight as a criterion in post-mortem diagnosis

Multiple endocrine neoplasia type 2B. A case report and review of the syndrome

This paper presents a case of the very rare multiple endocrine neoplasia Type 2B syndrome. It highlights that because of the presence of superficial neuromas in this condition, there is the possibility for early diagnosis. Recent knowledge of the molecular genetics of this syndrome and the ability to screen family members is also stressed since early thyroidectomy is now recommended to prevent the development of thyroid carcinoma which is the main determinant of prognosis

Scleroderma with cardiac tamponade, hyperthyroidism and incidental papillary thyroid carcinoma

Cardiac tamponade and malignancy are associated with a poor prognosis in Progressive Systemic Sclerosis (PSS). We present the case of a 31-year-old African-Jamaican woman with PSS and a thyroid neoplasm who presented with cardiac tamponade requiring pericardiocentesis. Despite the presence of two poor prognostic markers, she has had a favourable postoperative course.

Prostate cancer at the University Hospital of the West Indies in Jamaica. A clinico-pathological profile at the time of needle biopsy diagnosis

A prospective study of the clinico-pathological features of prostate cancer at the time of needle biopsy diagnosis was conducted in the Department of Pathology at the University Hospital of the West Indies over a one-year period. Ninety cases were diagnosed during this time. The mean age of patients at diagnosis was 72 years and the mean Gleason score of the biopsy, 7.3. Serum prostate-specific antigen levels were markedly elevated in the majority of patients, with a mean value of at least 159.8 ng/ml in the 76 patients for whom this information was available. The significance of these findings and that of other histopathological features examined are discussed, particularly in relation to recognized prognostic factors. It is concluded that the diagnosis of prostate cancer in Jamaica appears to be considerably later than that seen elsewhere. This information should provide support for those who advocate the introduction of a vigorous screening process for prostate cancer in Jamaica.

Cardiac rhabdomyoma in infancy. A case report

We describe a case of rhabdomyoma of the heart in a newborn infant and present an overview of current knowledge about the natural history of these lesions, with implications for management. This is the only case of its kind seen at this hospital.

Soft tissue sarcomas: a ten-year analysis

Malignant soft tissue tumours are uncommon and the diagnosis is often difficult to make. This study of fifty-nine cases represents a pathological perspective of our experience with these tumours over a 10-year period. Malignant fibrous histiocytoma was the most frequent diagnosis made (36) and the majority of these occurred in the lower limbs. In 11 (19) cases, the sarcomas could not be further classified along histogenetic lines. We consider some of the reasons for this and discuss these findings in the light of an increasing trend towards the use of smaller samples for diagnosis.

Nodular fasciitis

A 10-year review of the files of the Department of Pathology revealed 11 cases of nodular fasciitis. The clinicopathologic features of these cases are presented together with a discussion of the pathology of this lesion. The purpose of this study is to enhance both physicians' and pathologists' awareness of this entity.

Medical students' evaluation of their pathology clerkship experience

As part of a recent trend among faculties in educational institutions to review and upgrade their courses and teaching methods, the Department of Pathology introduced a questionnaire for assessment of the pathology clerkship experience by the medical students. This was to be completed at the end of their rotation. An evaluation of the results of an entire class indicates that, for the most part, the responses were positive with 82 considering the experience to be of great benefit and 17 of reasonable benefit. The responses were generally more favorable to Anatomical Pathology and Haematology than to Chemical Pathology. The study identified areas where modifications in teaching could be considered, and ways to improve the questionnaire, making it more useful for future assessments.

Right ventricular cardiomyopathy. A rare and underdiagnosed cause of sudden death in young adults

We present an example of right ventricular cardiomyopathy, a very uncommon condition which caused sudden death in an adolescent boy. This case report is used to highlight the pathological features of this rare and poorly understood condition, which is often undiagnosed.

Turnaround time in the surgical pathology laboratory

One measure of the efficiency of a surgical pathology service is the rapidity of reporting the diagnosis to clinicians. The turnaround time (TAT) has been used for this purpose. This study showed that the TAT for 66of specimens submitted to the surgical pathology laboratory in the University Hospital of the West Indies was within 3 days and for 89within 6 days. The TAT within 7 days was considered acceptable, but it was shown that it was more than 7 days for 9, of the specimens submitted. The importance of this information is discussed and recommendations made for identifying more accurately the source of delays in those cases in which the TAT was considered to be unusually prolonged.

Tumours and tumour-like lesions of bone. The UHWI experience. University Hospital of the West Indies

A review of all primary tumours and tumour-like lesions of bone diagnosed in patients who attended the University Hospital of the West Indies over a 10-year period revealed 136 cases comprising 69 benign and 54 malignant tumours, and 13 cases of tumour-like lesions. The prevalence and clinical characteristics of the various lesions are discussed and compared with the findings in other series. The results of this analysis provide demographic data useful in the differential diagnosis of bone lesions locally.

Torsion of an intra-abdominal testicle in a neonate. Case report and review of the literature

The thirty-ninth reported case of torsion of an intra-abdominal testicle is described in a neonate. The gonad was excised as is recommended because of the high incidence of malignancy (60of 37 cases). Torsion of an intra-abdominal testicle should be considered where an abdominal mass with calcification is found in an infant with undescended testis. Ultrasonography improves the diagnostic accuracy in infants because of the cystic nature of these masses in this age group.

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.

Appendicectomy at the University Hospital of the West Indies (1984-1988): A retrospective review

The pathological records of appendicectomy specimens from patients with suspected acute appendicitis at the University Hospital of the West Indies during the 5-year period 1984-1988 were studied. The numbers of cases, their ages, sex and seasonal incidence were similar to those of other studies. The over-all false positive diagnosis rate was 25%(16%in males, 38%in females). The main diagnostic difficulty was in young females in whom surgery for suspected appendicitis often proved unnecessary.

Aortic dissection: an autopsy experience

Aortic dissection was confirmed in 33 patients at autopsy at the University Hospital of the West Indies between 1975 and 1988. Twenty-five cases were acute and 8 chronic and the diagnosis was made ante-mortem in 5 cases overall. The high risk of rupture of proximal dissections involving the ascending aorta into the pericardial sac is clear, and the overriding importance of systemic hypertension is once again confirmed. An unusual finding was the higher proportion of females to males. A higher index of suspicion should permit an antemortem diagnosis and appropriate therapy in a larger proportion of patients

Meckel-Gruber syndrome: a lethal combination of abnormalities

We herein describe two cases of Meckel-Gruber Syndrome identified in stilborn infants. Both had all three elements of the classical triad, namely, occipital encephalocele, renal cystic dysplasia and post-axial polydactyly. In addition, many of the other well-known accompanying abnormalities were present. Awareness of this entity in this region is important because of its high risk of recurrence in subsequent pregnancies

Infective endocarditis at the University Hospital of the West Indies: a postmortem evaluation

Thirty cases of infective endocarditis identified in the autopsy of the University Hospital over a 10-year period are reviewed. The mean age of the patients was 30.6 years, and 70%) were below the age of 40 years. Sixty per cent of the cases had previous heart disease of which rheumatic heart disease was the most common. Degenerative heart disease and floppy mitral valve contributed one case each. The mitral valve was most commonly affected, and there were only 2 cases of right-sided endocarditis. Evidence of systemic embolization was present in 83% of the patients. The results of this stuy are compared with others from both developed and under-developed countries

Endodermal sinus (Yolk Sac) tumour of the mediastinum

An endodermal sinus tumour of the anterior mediatinum is described in a19-year-old man. This very rare condition is reported for the first time in the Caribbean literature