Ovarian Dermoid Cyst Causing Distal Ureteral Obstruction.

A case of a 45-year old woman with an ovarian dermoid cyst causing ureteric colic secondary to distal ureteral obstruction is reported. The dermoid cyst was observed on computed tomography to be adjacent to and compressing the distal left ureter and this was confirmed at surgical exploration. Following oophorectomy, the patient's symptoms completely resolved and the excised ovarian cyst was confirmed on pathological evaluation to be a dermoid cyst. This appears to be the first reported case of ureteral obstruction caused by an ovarian dermoid cyst in the English medical literature.

Prostate cancer in Jamaica and the wider Caribbean: it is time to consider screening.

Prostate cancer is a serious health problem in the Caribbean with high incidence and mortality rates affecting a predominantly Black population. Research is required to help elucidate the importance of locally relevant modifiable risk factors so that preventive strategies may be instituted both at the population and individual levels. Also, effective secondary preventive strategies such as mass screening and other interventions should be urgently considered to bring this common disease under control and reduce not only the mortality but the morbidity and accompanying caregiver burden.

Historical determinants of contemporary attributes of African descendants in the Americas: the androgen receptor holds the key.

It is hypothesised that seemingly disparate and unrelated phenomena clustering in persons of African descent living in the Americas such as outstanding sprinting ability and high prostate cancer incidence and mortality are in fact related and emerge from enhanced testosterone responsiveness in descendants of African slaves surviving the transatlantic trade in Africans. It is postulated that the ability to have survived the middle passage was positively correlated with greater responsiveness of the androgen receptor to its primary ligands dihydrotestosterone and testosterone, and that slaves possessing more responsive androgen receptors experienced a survival advantage engendered by the enhanced anabolic effects which accrued such as increased red cell mass and therefore greater oxygen carrying capacity and tissue oxygen delivery enabling these slaves to tolerate stifling conditions in the hull of the slave ship, increased lean muscle mass and therefore greater surface area to volume ratio resulting in easier ability to dissipate heat and remain cool, and increased skin thickness and sebum production resisting the macerating effect of lying in admixed bodily fluids below deck. These androgen effects as well as others would have produced a survival advantage under the severe selection pressure created by the inhumane and physiologically challenging circumstances under which the slaves were transported from the interior of the African continent and West Africa to the 'New World'. This would result in a population shift favouring increased androgen receptor responsiveness in descendants of African slaves populating the Americas and a corresponding geographic and racial distribution of androgen related phenomena such as sprinting prowess and prostate cancer. African-Americans having the highest prostate cancer incidence rate and the Caribbean having the highest prostate cancer mortality rates in the world are consistent with this hypothesis as is the observation that the 10 fastest men and 9 fastest women of all time are exclusively the descendants of West African slaves who survived the middle passage. It is predicted that as yet undiscovered as well as known biological correlates of enhanced androgen receptor responsiveness such as relatively short CAG-repeats in the poly Q tail of exon 1 of the androgen receptor gene will be more prevalent among African-Americans and Afro-Caribbean peoples than among West Africans. It is also predicted that African-Americans and Afro-Caribbean peoples will have relatively shorter CAG-repeats in the androgen receptor gene compared to West Africans.

Body mass index and prostate specific antigen levels in Jamaican men.

OBJECTIVE: To investigate the relationship between body mass index (BMI) and prostate specific antigen (PSA) levels in Jamaican men. METHODS: Men, 40-79 years old, attending public and private urology clinics in Kingston, Jamaica were recruited to a case-control study on the role of dietary and lifestyle factors on prostate cancer. Trained interviewers administered questionnaires and measured weight and height using standardized techniques. Blood samples for PSA were measured at a central laboratory using a micro-particle enzyme immunoassay method. Prostate biopsy was used to confirm prostate cancer. Multivariable linear regression was used to examine the relationship between BMI and PSA separately in the cases and controls. RESULTS: Data from 501 men (233 cases and 263 controls) were assessed. Thirty-five per cent of subjects were overweight and 13% were obese. Among cases, the median PSA was 35.3 ng/dL in normal weight, 26.1 ng/dL in overweight and 14.5 ng/dL in obese men (p = 0.02). For controls, median PSA was 2.0 ng/dL in normal weight, 1.3 ng/dL in overweight and 1.1ng/dl in obese men (p = 0.01). Among cases, BMI was negatively associated with PSA (B(SE) per 5 kg/m2 (BMI difference = -0.51 (0.13); p < 0.01) and remained significant after adjustment for age, sexual activity, smoking, use of statins and tumour grade. For controls, the BMI was also inversely related to the PSA (B(SE) per 5 kg/m2 difference -0.17 (0.07)) but the effect became of borderline significance after adjusting for age. CONCLUSIONS: Prostate specific antigen was inversely related to body mass index in Jamaican men with prostate cancer. Clinicians should consider this association when interpreting PSA results.