Ameloblastoma in Jamaica - predominantly unicystic: analysis of 47 patients over a 16-year period and a case report on re-entry cryosurgery as a new modality of treatment for the prevention of recurrence / El ameloblastoma en Jamaica - predominantemente unicístico: análisis de 47 pacientes por un período de más de 16 años y un reporte de caso de criocirugía de reentrada como nueva modalidad de tratamiento para prevenir la recurrencia

OBJECTIVE: To analyse all the cases of ameloblastoma seen in the two major public Hospitals in Jamaica over a 16year period, and to compare the results with what has been previously documented by other authors in the literature. A new treatment modality for prevention of recurrence of ameloblastoma is described. SUBJECTS AND METHODS: The case files of patients histologically diagnosed to have ameloblastoma at both the Kingston Public Hospital and Cornwall Regional Hospital in Jamaica from 1980 to 1995 were retrieved and information about this odontogenic tumour was documented. The analysis revealed that uncystic ameloblastoma was predominant (95%) and solid ameloblastoma was about 5%. It was not therefore surprising that the average age in the study was 29.1 years, with a peak in the 10-19year age group. No peripheral ameloblastoma was diagnosed. RESULTS: A total of 47 new cases of ameloblastoma was recorded between 1980 and 1995. This number accounted for 16.03% of all jaw bone lesions in Jamaica and 38.2% of jaw bone lesions of odontogenic origin during this period. These cases of ameloblastoma accounted for 67% of odontogenic tumours with the exception of the odontomas. The mean age was 29.1 (range 13-67) years. The male: female ratio was 1: 1.14). Only 3 cases involved the maxilla. Of significance, is the case of bilateral ameloblastoma with no continuity to the anterior region, and also the case of unilateral involvement of the mandible and the maxilla in the same patient. Reentry cryosurgery (a procedure in which cryosurgery is done after a specified period from the primary surgical procedure) after excisional biopsy of a relatively small cystic ameloblastoma of the maxilla was negative for recurrence. CONCLUSION: The clinicopathological presentation of ameloblastoma in Jamaica is not different from what has been documented by other authors throughout the world; however, we report two unique cases - a case of bilateral ameloblastoma of the mandible and a case of unilateral involvement of the mandible and maxilla in the same patient. We suggest that reentry cryosurgery before recurrence be considered in the management of ameloblastoma for the prevention of recurrence.

OBJETIVO: Analizar todos los casos de ameloblastoma vistos en los dos principales hospitales públicos en Jamaica durante un período de 16 años, y comparar los resultados con la información previamente documentada por otros autores en la literatura. Se describe una nueva modalidad de tratamiento para prevenir la recurrencia del ameloblastoma. SUJETOS Y MÉTODO: Se recuperaron los expedientes de los pacientes diagnosticados histológicamente con ameloblastoma en el Hospital Público de Kingston y el Hospital Regional de Cornwall en Jamaica desde 1980 a 1995, y se obtuvo información documentada acerca de este tumor odontogénico. El análisis reveló que el ameloblastoma unicístico era predominante (95%), en tanto que el ameloblastoma sólido fue de alrededor del 5%. Por lo tanto, no fue sorprendente que la edad promedio en el estudio fuera 29.1 años, con un pico en el grupo etario de 10 a 19 años. No se diagnosticó ningún ameloblastoma periférico. RESULTADOS: Entre 1980 y 1995, se registró un total de 47 nuevos casos de ameloblastoma. Este número representaba el 16.03% de todas las lesiones óseas de mandíbula en Jamaica y 38,2% de las lesiones de hueso de la mandíbula de origen odontogénico durante este período. Estos casos de ameloblastoma representaron el 67% de los tumores odontogénicos con la excepción de los odontomas. La edad promedio fue 29.1 años (rango 13-67). La proporción hombre:mujer fue de 1: 1.14. Sólo tres casos implicaron el maxilar. Resulta particularmente importante el caso del ameloblastoma bilateral sin ninguna continuidad a la región anterior, así como el caso de la participación unilateral de la mandíbula y el maxilar en el mismo paciente. La criocirugía de reentrada (un procedimiento en el cual la criocirugía se realiza después de un período especificado a partir del procedimiento quirúrgico primario) después de la biopsia por escisión de un ameloblastoma quístico del maxilar relativamente pequeño, fue negativa para la recurrencia. CONCLUSIÓN: La manifestación clínicopatológica del ameloblastoma en Jamaica no difiere de lo que ha sido documentado por otros autores en todo el mundo. Sin embargo se reportan dos casos únicos: un caso de ameloblastoma bilateral de la mandíbula y un caso de compromiso unilateral de la mandíbula y el maxilar en el mismo paciente. Sugerimos que se tenga en cuenta la criocirugía de reentrada a la hora de tratar el ameloblastoma para prevenir la recurrencia.

Duodenal fibrosarcoma mimicking Franz tumour complicated by post-resection chylous ascites: a case report / Fibrosarcoma duodenal con apariencia de tumor de Franz complicado por ascitis quilosa post-resección: reporte de un caso

This case report presents a young woman who underwent a Whipples resection for a large pancreato-duodenal tumour. Pathology and immunohistochemical analysis of the tumour suggest duodenal fibrosarcoma. The patient's postoperative management was complicated by chylous ascites. A brief literature review is given to highlight this unusual case.

Este reporte presenta el caso de una mujer joven a la cual se le practicó una resección de Whipples a causa de un tumor pancreato-duodenal grande. La patología y el análisis imunohistoquímico del tumor sugieren la existencia de un fibrosarcoma duodenal. El tratamiento postoperatorio del paciente estuvo complicado por una ascitis quilosa. Se ofrece una breve revisión de la literatura para resaltar este caso inusual.

Review of six cases of maxillary ameloblastoma from the west indies re-entry cryosurgery as prophylactic surgical intervention / Revisión de seis casos de ameloblastoma maxilar de criocirugía de reentrada de west indies como intervención quirúrgica profiláctica

Maxillary ameloblastoma is a rare histopathological entity. A total of six cases of histologically confirmed maxillary ameloblastoma from the West Indies is reviewed. Three of the cases were taken from a total of 47 histologically confirmed ameloblastoma over a 15-year period (1980- 1995) from two major maxillofacial units in Jamaica. Two other cases were from documentation in Jamaica between 2000 and 2002, one of which occurred in a 13-year old girl (these two patients have been followed-up periodically to 2006). The sixth case was from the records of the maxillofacial department of the University of the West Indies in Trinidad and Tobago. This last patient, at a recent review, has inoperable recurrence. These cases were reviewed with respect to demographics (patient's age and gender), location and extent oftumour, radiological features, concurrent involvement ofthe mandible, treatment with special emphasis on current treatment modality and follow-up. The findings do not differ from what has been documented by other authors from other parts ofthe world. Because of the radiographic anatomy of the maxilla, recurrence may be detected late despite such occurring earlier following initial surgical management. It is for this reason that we suggest re-entry cryosurgery for prevention ofrecurrence for maxillary ameloblastoma. The only case ofmaxillary ameloblastoma that had re-entry cryosurgery continues to benefit from absence ofrecurrence at periodic follow-ups at four years post-primary surgical management (which was enucleation).

El ameloblastoma maxilar es una entidad histopatológica rara. Se examinan un total de seis casos ameloblastoma maxilar en West Indies, histológicamente confirmados. Tres de los casos fueron tomados de un total de 47 ameloblastomas histológicamente confirmados en un periodo de 15 años (1980-1995) en dos unidades maxilofaciales de Jamaica. Otros dos casos proceden de documentación en Jamaica entre 2000 y 2002, uno de los cuales ocurrió en una niña de 13 años (estos dos pacientes tuvieron un seguimiento periódico hasta el 2006). El sexto caso proviene de las historias del departamento maxilofacial de la Universidad de West Indies en Trinidad y Tobago. Este último paciente - en una revisión reciente - presentaba una recurrencia inoperable. Estos casos se examinaron con respecto a los datos demográficos (la edad y el género del paciente), la situación y magnitud de tumor, rasgos radiológicos, compromiso concurrente de la mandíbula, tratamiento con énfasis especial en la modalidad del tratamiento actual y el seguimiento. Los hallazgos no difieren de lo documentado por otros autores de otras partes del mundo. Debido a la anatomía radiográfica del maxilar superior, la recurrencia puede ser detectada tarde, a pesar de que ocurra temprano tras el tratamiento quirúrgico inicial. Es por esta razón que sugerimos la criocirugía de reentrada para prevenir la recurrencia del ameloblastoma maxilar. El único caso de ameloblastoma maxilar que tuvo criocirugía de reentrada continúa beneficiándose de la ausencia de recurrencia en los seguimientos periódicos a cuatro años de tratamiento quirúrgico post-primario (que consistió en una enucleación).

A Caribbean perspective on Barrett's oesophagus / Una perspectiva caribeña sobre el esófago de barrett

The aim of this study is to evaluate the prevalence of Barrett's oesophagus at the University Hospital of the West Indies which serves a population predominantly of African descent. In order to maximize accession of all cases in this preliminary study, the broad definition of columnar metaplasia of the lower oesophagus was utilized. Nevertheless, of 18 cases identified in the 21-year period, 14/17 cases (82) available for review had specialized columnar epithelium diagnostic of Barrett's oesophagus. There was male predominance 5:1, the mean age was 53.8 years and there were two associated adenocarcinomas. These data confirm the occurrence but low prevalence of Barrett's oesophagus in this population but with a disease pattern that is consistent with that reported in other populations, warranting systematic evaluation of the gastro-oesophageal junction even in a Caribbean population.

El objetivo de este estudio es evaluar la prevalencia del esófago de Barrett en el Hospital Universitario de West Indies – institución que presta servicio a una población predominantemente de descendencia africana. Con el objeto de maximizar el acceso de todos los casos a este estudio preliminar, se utilizó la definición amplia de metaplasia columnar del esófago inferior. Sin embargo, de 18 casos identi-ficados en un período de 21 años, 14/17 casos (82%) disponibles para examen presentaban diagnós-tico de epitelio columnar especializado de esófago de Barrett. Hubo predominio masculino 5:1, la edad media fue de 53.8 años, y hubo dos adenocarcinomas asociados. Estos datos confirman la incidencia, pero a la vez la baja prevalencia del esófago de Barrett en esta población, aunque con un patrón de en-fermedad consistente con el que se reporta para otras poblaciones, justificando la evaluación sistemá-tica de la unión gastroesofágica incluso en una población caribeña.

An unusual presentation of group B streptococcal sepsis

This paper describes the devastating outcome of a neonate who presented with severe late onset group B beta-haemolytic streptococcal (GBS) disease. There were extensive infarcts of the brain and gangrene of the toes. The purpose of this report is to alert healthcare workers of the unusual presentation and that fatal late onset group B beta-haemolytic streptococcal disease may occur despite early and effective management

Cadmium levels in kidney and liver of Jamaicans at autopsy

The cadmium concentrations in the kidneys and livers of 39 autopsy cases in Jamaica, in the age group > or = 40 years, are renal cortex: range 6.7-126 mg kg-1, mean 43.8 mg kg-1; liver: range 0.3-24.3 mg kg-1, mean 5.3 mg kg-1. The mean levels in the renal cortex are higher for women than for men but not so significantly, nor are the differences between smokers and non-smokers clear. The observed values are considered high, second only to Japan where cadmium related health impairments have occurred, and nearly twice as high as the values reported from Austria, Australia, the United Kingdom and Sweden. The Jamaican cases were from areas with relatively low soil-cadmium concentrations, and the corresponding values are likely to be significantly higher in central Jamaica where the soil contains unusually high levels of cadmium. An examination of possible contributions of cadmium intake to renal problems in Jamaica now appears to be necessary

Hepatic abscesses at the University Hospital of the West Indies. A 24-year autopsy review

A retrospective review of all hepatic abscesses identified at autopsy over the 24-year period 1977-2000 at the University Hospital of the West Indies (UHWI), Kingston, Jamaica, was conducted. Post mortem and microbiology records were reviewed. Data collected included age, gender, predisposing factors, organisms isolated, number of abscesses and associated conditions, such as diabetes mellitus. Data for the adults was analyzed separately. Thirty-nine cases of pyogenic abscesses were identified from 7480 post-mortems. Thirty-three occurred in adults of mean age 59.5 years. Sixty per cent of the abscesses were solitary. Biliary tract disease was the predisposing factor in 33 of cases. Six per cent were cryptogenic: 11/33 patients were diabetic and these were significantly older than non-diabetics (p < 0.014) Klebsiella pneumoniae was the most common organism isolated from diabetics (6.9). Only 2/33 abscesses were diagnosed ante-mortem. The abscesses in children were more frequently multiple and associated with extra-abdominal infection. Gram positive cocci were the commonly isolated organisms in children. There were no cases of amoebic abscess. The prevalence of hepatic abscess was low. Diabetes mellitus was a significant contributing factor. A high index of clinical suspicion is therefore warranted particularly in elderly diabetics

Smooth muscle tumours of the vulva in Jamaica

Smooth muscle tumours of the vulva are uncommon and their behaviour is unpredictable. A 30-year retrospective analysis of the pathology files and patient records revealed 10 cases diagnosed at the University Hospital of the West Indies, Kingston, Jamaica, with one malignant and one recurrent tumour. Size, infiltrating margins and mitotic count are important parameters to determine prognosis. Although these tumours are of low malignancy, mitotic count may be mandatory in determining their potential for recurrence

Colonic lipomas at the University Hospital of the West Indies

Lipomas of the colon are uncommon but cause diagnostic difficulty when they are symptomatic. The clinical and pathological features of 17 cases of colonic lipomas diagnosed at the University Hospital of the West Indies between 1970 and 1999 are reported. Ten cases were symptomatic, two of these being diagnosed with adult intussusception. Six patients had incidental lipomas in bowel resected for other pathology while one lipoma was diagnosed on sigmoidoscopy. Increased awareness of these lesions will enhance pre-operative diagnostic accuracy.

Salivary gland lesions: a Jamaican perspective

A retrospective analysis of the spectrum and relative frequency of salivary gland lesions diagnosed in the Department of Pathology, University of the West Indies, Kingston, Jamaica, between 1965 and 1994, is reported. Four hundred and sixty-four salivary gland biopsies were received. Of these 99 (21.3) were non-neoplastic and the remaining 365 (78.7) were neoplasms: 261 (71.5) were benign and 104 (28.5) malignant. Benign mixed tumour (BMT)/pleomorphic adenoma (PA) was the most common neoplasm (63.3) while mucoepidermoid carcinoma (MEC) was the most common malignant neoplasm (9.6), followed by adenoid cystic carcinoma (ACC) (7.4). The increased frequency of MEC over ACC is at variance with other reported series but the preponderance of pleomorphic adenoma is consistent. In the major salivary glands, benign neoplasms predominate at a ratio of 3:1, while a higher proportion of minor salivary gland neoplasms was malignant, ratio 1.2:1 (p = 0.003). These data represent the first attempt to document the spectrum of disease related to oral and maxillofacial pathology in Jamaica.

Malignant lymphoma of gastric mucosa-associated lymphoid tissue in Jamaica

The recently appreciated concept of Mucosa-Associated Lymphoid Tissue (MALT) and the characteristics of the lymphomas arising therein are discussed with reference to the clinical, histological and immunohistochemical features of the first four cases of gastric MALT lymphomas diagnosed at the University Hospital of the West Indies. These tumours are low-grade B-cell lymphomas, which may undergo high-grade transformation. They are aetiologically associated with Helicobacter pylori (H pylori) infection in the stomach and may be cured in the early stages with antibiotics. Our cases were diagnosed from gastrectomy specimens removed for suspected carcinoma. All were high-grade, and associated with H pylori; 3 cases presented as advanced disease. Documentation of the features of these lymphomas will increase awareness and earlier recognition.

Hepatic cirrhosis in Jamaica

The aetiology, biochemistry, clinical features and complications of histologically confirmed hepatic cirrhosis in 45 patients (26 females, 19 males) seen at the University Hospital of the West Indies, Jamaica, between 1984 and 1994 was presented. The age range was 1 to 72 years (mean 48 years). Abdominal swelling and weight loss were the commonest symptoms, occurring in 51 percent and 47 percent of patients, respectively. Jaundice was a presenting feature in 44 percent. Hepatomegaly was present in 71 percent of patients and splenomegaly in 33 percent. The aetiological factors were: alchol (36 percent), bush tea (18 percent), chronic active hepatitis (11 percent), drugs (7 percent), and haemochromatosis (2 percent). Hepatitis B surface antigen was detected in 2 of 20 patients tested. 24 percent of the patients also had diabetes mellitus, 29 percent were anaemic, 29 percent were thrombocytopenic, 4 percent were leukopenic, and the prothrombin time was prolonged in 22 percent. The albumin/globulin ratio was reversed in 71 percent of the patients. The alkaline phosphatase was elevated in 56 percent, the aspartate aminotransferase was increased in 58 percent and the gamma glutamyl transpeptidase in 56 percent. 56 percent of the patients had macronodular cirrhosis; the liver showed a micronodular pattern in 18 percent; 7 percent had biliary cirrhosis; 7 percent chronic active hepatitis with cirrhosis; and 13 percent showed a mixed macro-micronodular pattern. Ascites and fluid overloaded developed in 44 percent of the patients. Hepatic encephalopathy occurred in 18 percent and upper gastrointestinal bleeding in 18 percent.

Amoebiasis in Jamaica: a forgotten cause of hepato-intestinal disease

Amoebiasis still occurs in Jamaica. This paper describes the unexpected occurrence of the disease in three adult males, two with colitis and the other with an hepatic abscess. This to our knowledge, is the first report of amoebiasis in Jamaica for over two decades and serves to underscore the continued need for the inclusion of amoebiasis in the differential diagnosis of unexplained hepato-intestinal disease

Concurrent multicentric angiofollicular lymph node hyperplasia and peripheral T-cell lymphoma

Multicentric angiofollicular lymph node hyperplasia (MAFH) is a variant of Castleman's disease, localized angiofollicular lymph node hyperplasia. Unlike Castleman's disease, MAFH sometimes runs an aggressive clinical course culminating in death, mainly from infection and rarely from malignant lymphoma. the lymphoma may develop months or years after the onset of MAFH but may be present at the time of diagnosis. In this paper, we present a case of MAFH with co-existing peripheral T-cell lymphoma, in a 59-year-old man who died from disseminated disease. This adds another to the list of five such cases recorded in the literature since the recognition of MAFH

A key for identifying faecal smears to detect domestic infestations of triatomine bugs

Determinar as populaçöes de barbeiros residuais nas casas depois de borrifaçäo com inseticidas é um componente importante na vigilânica e evoluçäo do controle dos vetores da doença de Chagas. Recentemente, mostramos que folhas de papel, afixadas na parede das casas infestadas, podem ser manchadas com fezes dos triatomíneos, assim revelando a infestaçäo. Apresenta-se uma chave simples para diferenciar as fezes dos triatomíneos de outros artropodos, como baratas, carrapatos e percevejos de cama